Hamstring graft bacterial contamination during anterior cruciate ligament reconstruction: clinical and microbiological study.

PubMed

Badran, Mohamad Aboelnour; Moemen, Dalia Mohamed

2016-09-01

Autograft preparation for anterior cruciate ligament (ACL) reconstruction has a potential for graft contamination. The purpose of this study was to evaluate the possibility of bacterial contamination of hamstring autograft during preparation and when dropped onto the operating room floor and methods of graft decontamination. Sixty hamstring tendon autograft specimens were used as the test group. Excess tendon not used in the ACL procedure was divided into five segments. One segment, at the completion of preparation, was sent for culture as a control; the remaining four segments were dropped onto the floor adjacent to the surgical field for 15 seconds. One segment was cultured without undergoing any further treatment. Cultures were taken from each segment after immersion in 10 % povidone-iodine solution, 4 % chlorhexidine and bacitracin, respectively, for three minutes. Cultures of a skin swab and floor swab were taken at the same time and place that the ACL was dropped. Cultures of control graft tissue from ten patients (16.7 %) were positive for bacteria. No patient developed post-operative infection. Ninety organisms were identified, with Staphylococcus epidermidis being the most common isolate. Grafts rinsed in either bacitracin or 4 % chlorhexidine solutions were less likely to be culture positive. A high rate of contamination can be expected during autograft preparation for ACL reconstruction. Soaking the hamstring autograft in either bacitracin or 4 % chlorhexidine solution is effective for decontamination, particulary if graft is dropped on the floor.

Predictors and effects of patellofemoral pain following hamstring-tendon ACL reconstruction.

PubMed

Culvenor, Adam G; Collins, Natalie J; Vicenzino, Bill; Cook, Jill L; Whitehead, Timothy S; Morris, Hayden G; Crossley, Kay M

2016-07-01

Patellofemoral pain is a frequent and troublesome complication following anterior cruciate ligament reconstruction (ACLR), irrespective of graft source. Yet, little is known about the factors associated with patellofemoral pain following hamstring-tendon ACLR. Retrospective analysis of potential patellofemoral pain predictors, and cross-sectional analysis of possible patellofemoral pain consequences. Potential predictors (pre-injury patellofemoral pain and activity level, concomitant patellofemoral cartilage damage and meniscectomy, age, sex, and surgical delay) and consequences (hopping performance, quality of life, kinesiophobia, and return to sport rates and attitudes) of patellofemoral pain 12 months following hamstring-tendon ACLR were assessed in 110 participants using univariate and multivariate analyses. Thirty-three participants (30%) had patellofemoral pain at 12 months post-ACLR. Older age at the time of ACLR was the only predictor of post-operative patellofemoral pain. Following ACLR, those with patellofemoral pain had a higher body mass index, and worse physical performance, quality of life, kinesiophobia and return to sport attitudes. Patellofemoral pain has a significant burden on individuals 12 months following hamstring-tendon ACLR. Clinicians need to be cognisant of patellofemoral pain, particularly in older individuals and those with a higher body mass index. The importance of considering psychological factors that are not typically addressed during ACLR rehabilitation, such as kinesiophobia, quality of life and return to sport attitudes is emphasised. Copyright © 2016. Published by Elsevier Ltd.

Anterior Cruciate Ligament Reconstruction with Tibial Attachment Preserving Hamstring Graft without Implant on Tibial Side

PubMed Central

Sinha, Skand; Naik, Ananta Kumar; Maheshwari, Mridul; Sandanshiv, Sumedh; Meena, Durgashankar; Arya, Rajendra K

2018-01-01

Background: Tibial attachment preserving hamstring graft could prevent potential problems of free graft in anterior cruciate ligament (ACL) reconstruction such as pull out before graft-tunnel healing or rupture before ligamentization. Different implants have been reportedly used for tibial side fixation with this technique. We investigated short-term outcome of ACL reconstruction (ACLR) with tibial attachment sparing hamstring graft without implant on the tibial side by outside in technique. Materials and Methods: Seventy nine consecutive cases of ACL tear having age of 25.7 ± 6.8 years were included after Institutional Board Approval. All subjects were male. The mean time interval from injury to surgery was of 7.5 ± 6.4 months. Hamstring tendons were harvested with open tendon stripper leaving the tibial insertion intact. The free ends of the tendons were whip stitched, quadrupled, and whip stitched again over the insertion site of hamstring with fiber wire (Arthrex). Single bundle ACLR was done by outside in technique and the femoral tunnel was created with cannulated reamer. The graft was pulled up to the external aperture of femoral tunnel and fixed with interference screw (Arthrex). The scoring was done by Lysholm, Tegner, and KT 1000 by independent observers. All cases were followed up for 2 years. Results: The mean length of quadrupled graft attached to tibia was 127.65 ± 7.5 mm, and the mean width was 7.52 ± 0.78 mm. The mean preoperative Lysholm score of 47.15 ± 9.6, improved to 96.8 ± 2.4 at 1 year. All cases except two returned to the previous level of activity after ACLR. There was no significant difference statistically between preinjury (5.89 ± 0.68) and postoperative (5.87 ± 0.67) Tegner score. The anterior tibial translation (ATT) (KT 1000) improved from 11.44 ± 1.93 mm to 3.59 ± 0.89 mm. The ATT of operated knee returned to nearly the similar value as of the opposite knee (3.47 ± 1.16 mm). The Pivot shift test was negative in all cases

ACL reconstruction with hamstring tendon autograft and accelerated brace-free rehabilitation: a systematic review of clinical outcomes

PubMed Central

van Melick, Nicky; van Mourik, Jan B A; Reijman, Max; van Rhijn, Lodewijk W

2018-01-01

Objective To investigate the clinical outcomes after hamstring tendon autograft ACL reconstruction (ACLR) with accelerated, brace-free rehabilitation. Design Systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Data sources Embase, MEDLINE Ovid, Web of Science, Cochrane CENTRAL and Google scholar from 1 January 1974 to 31 January 2017. Eligibility criteria for selecting studies Study designs reporting outcomes in adults after arthroscopic, primary ACLR with hamstring autograft and accelerated, brace-free rehabilitation. Results Twenty-four studies were included in the review. The clinical outcomes after hamstring tendon autograft ACLR with accelerated brace-free rehabilitation were the following: (1) early start of open kinetic exercises at 4 weeks in a limited range of motion (ROM, 90°−45°) and progressive concentric and eccentric exercises from 12 weeks did not alter outcomes, (2) gender and age did not influence clinical outcomes, (3) anatomical reconstructions showed better results than non-anatomical reconstructions, (4) there was no difference between single-bundle and double-bundle reconstructions, (5) femoral and tibial tunnel widening occurred, (6) hamstring tendons regenerated after harvest and (7) biological knowledge did not support return to sports at 4–6 months. Conclusions After hamstring tendon autograft ACLR with accelerated brace-free rehabilitation, clinical outcome is similar after single-bundle and double-bundle ACLR. Early start of open kinetic exercises at 4 weeks in a limited ROM (90°−45°) and progressive concentric and eccentric exercises from 12 weeks postsurgery do not alter clinical outcome. Further research should focus on achievement of best balance between graft loading and graft healing in the various rehabilitation phases after ACLR as well as on validated, criterion-based assessments for safe return to sports. Level of evidence Level 2b; therapeutic outcome studies

Five-Strand versus Four-Strand Hamstring Tendon Graft Technique for Anterior Cruciate Ligament Reconstruction: A Biomechanical Comparison.

PubMed

Vaillant, Eric R; Parks, Brent G; Camire, Lyn M; Hinton, Richard Y

2017-11-01

The aim of this article is to compare diameter and stiffness, displacement, and strain in a five-strand versus four-strand hamstring graft for anterior cruciate ligament reconstruction. Eight matched pairs of lower extremities underwent four-strand or five-strand hamstring graft reconstruction. Diameter was significantly higher in the five-strand versus the four-strand construct ( p  = 0.002). No significant difference was found between the groups in construct displacement or stiffness. Significantly higher strain was observed in the inner limb versus the outer limb in the four-strand construct ( p  = 0.001) and in the inner limb versus the fifth limb in the 5-strand construct ( p  = 0.004). A fifth limb added to a four-strand hamstring graft significantly increased graft diameter but did not significantly change stiffness or displacement, suggesting that attachment of additional graft material via suture did not provide for full incorporation of the added limb into the graft at time zero. The inner limb in both constructs absorbed significantly greater load than did other limbs. The use of suture to attach additional material to a four-strand hamstring graft may not contribute to improved biomechanical qualities of the graft at time zero. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

In vitro structural properties of braided tendon grafts.

PubMed

Nicklin, S; Waller, C; Walker, P; Chung, W K; Walsh, W R

2000-01-01

In an effort to increase strength in hamstring tendon grafts for anterior cruciate ligament reconstruction, braiding or weaving of the tendons has been suggested. The purpose of this study was to examine the biomechanical properties of two braiding techniques compared with a four-stranded tendon graft using a sheep model. Digital extensor tendons from 5 adult sheep were harvested in 28 matched pairs and randomly allocated to French plait or four-stranded weave. The grafts were tested in a hydraulic testing machine with the tendons secured in brass grips frozen with liquid carbon dioxide. The tendons were preconditioned to a distraction of 1 mm for 10 cycles followed by testing to failure at 50 mm/sec, with a data acquisition rate of 1,000 Hz. The stiffness, ultimate load to failure, and the mode of failure were recorded. All braided samples failed at the midsubstance, while the four-stranded controls failed at the grip interface. There was a significant reduction in strength and stiffness of the braided samples compared with the controls. This study demonstrated that braiding decreases the strength and stiffness of a four-stranded tendon graft by up to 54% and 85%, respectively. This finding is supported by the work of Hearle et al. (1969), who demonstrated that the decrease in strength of fiber bundles is equal to the square of the cosine of the twist angle. The twist angle in our samples was approximately 45 degrees, which equates to a decrease in strength of 50%.

Bioresorbable pins and interference screws for fixation of hamstring tendon grafts in anterior cruciate ligament reconstruction surgery: a randomized controlled trial.

PubMed

Stengel, Dirk; Casper, Dirk; Bauwens, Kai; Ekkernkamp, Axel; Wich, Michael

2009-09-01

Biodegradable cross-pins have been shown to provide higher failure loads than do screws for fixation of hamstring tendons under laboratory conditions. To compare the clinical results of biodegradable pins (RigidFix) and interference screws (BioCryl) for fixation of hamstring grafts in arthroscopically assisted anterior cruciate ligament reconstruction. Study Design Randomized controlled trial; Level of evidence, 1. To test the hypothesis of a difference of 1.0 +/- 1.2 mm in anterior knee laxity between the two fixation options, 54 patients were randomly assigned to groups via a block randomization scheme and sealed envelopes. All patients underwent standardized hamstring graft reconstruction and had similar postoperative aftercare by an accelerated rehabilitation protocol. Measures assessed at baseline and after 1 and 2 years of follow-up included (1) the side-to-side difference in anterior laxity (KT-1000 arthrometer), (2) Short Form 36 physical and mental component scores, and (3) the International Knee Documentation Committee form scores. After 1 and 2 years, 26 and 21 patients in the BioCryl group and 28 and 24 patients in the RigidFix group were available for follow-up examination. No significant difference was noted in instrumented anterior translation between BioCryl and RigidFix fixation: 1 year, 0.11 (95% CI, -0.60 to 0.82; P = .7537); 2 years, 0.33 (95% CI, -0.43 to 1.08 mm; P = .3849). Also, there were no significant differences in the mean physical and mental component scores and International Knee Documentation Committee form scores and in overall complication and surgical revision rates. A pin dislocation was classified as the sole procedure-specific serious adverse event. Bioresorbable pins do not provide better clinical results than do resorbable interference screws for hamstring graft fixation in anterior cruciate ligament reconstruction surgery.

MRI appearance of the proximal hamstring tendons in patients with and without symptomatic proximal hamstring tendinopathy.

PubMed

De Smet, Arthur A; Blankenbaker, Donna G; Alsheik, Nila H; Lindstrom, Mary J

2012-02-01

The purpose of our study was to determine if six MRI findings of the proximal hamstrings differ in frequency in hamstrings with and without symptoms of tendinopathy. We reviewed the MRI examinations of 118 consecutive patients who had undergone pelvis MRI and evaluation by a musculoskeletal clinical specialist. The proximal hamstrings were evaluated at four consecutive axial locations for tendon size, internal T1 and T2 signal, peritendinous T2 signal, and ischial tuberosity edema. Statistical analysis was performed to determine the association of the MRI findings with symptomatic hamstring tendinopathy. Twenty-one patients had a clinical diagnosis of unilateral proximal hamstring tendinopathy. The mean width or anteroposterior size was significantly larger in symptomatic hamstrings at all three proximal levels (p = 0.002-0.040). More than 90% of hamstring tendons had increased internal T1 or T2 signal that was not associated with hamstring symptoms. Both hamstrings with and without symptoms of tendinopathy had peritendinous T2 signal, but this was significantly more common in hamstrings with tendinopathy symptoms at the three most distal levels (p = 0.001-0.041). Ischial tuberosity edema and a feathery appearance of the peritendinous T2 signal distally were significantly more common in symptomatic hamstrings (p = 0.004 and 0.001, respectively). Increased T1 and T2 signal is commonly seen within the proximal hamstrings but is not associated with symptoms of hamstring tendinopathy. Increased tendon size, peritendinous T2 signal with a distal feathery appearance, and ischial tuberosity edema are significantly associated with symptomatic hamstring tendinopathy but can be seen in asymptomatic individuals.

Medial Patellofemoral Ligament Reconstruction Using the Hamstring Tendon for Patellofemoral Joint Instability in an 81-Year-Old Female.

PubMed

Takahashi, Tsuneari; Takeshita, Katsushi

2017-01-01

Chronic patellofemoral instability occurs mainly in adolescent females and can also be induced by medial patellofemoral ligament (MPFL) injury. There are no case reports of MPFL reconstruction for chronic patellofemoral instability due to MPFL injury in aged populations. 81-year-old female presented with left knee pain, giving way, and patellar instability while climbing stairs, which continued for 18 months. Patellar apprehension test was positive, and roentgenogram showed lateral patellar subluxation. Conservative therapy was not successful; hence, we performed a lateral release and MPFL reconstruction surgery. After arthroscopic lateral release, the hamstring tendon was harvested, and a graft composite made of doubled hamstring tendon and polyester tape with a suspensory fixation device was prepared. Then, a femoral bone tunnel was constructed in a socket shape at the anatomical footprint of the MPFL. The graft was passed through the femoral tunnel, and free ends of the graft composite were sutured to the periosteum of the patella, using two suture anchors at 60° of knee flexion with patellar reduction. Physiotherapy was gradually started using a patella-stabilizing orthosis on the first postoperative day. Her Kujala score improved from 66 to 97 points, and Barthel index score improved from 70 to 100 points at 1 year after surgery. She neither developed patellofemoral joint OA nor had any recurrence of symptoms at the 5-year postoperative follow up. MPFL reconstruction using the hamstring tendon is an effective procedure for patients with chronic patellofemoral instability even after the age of 80 years.

Risk of iatrogenic injury to the infrapatellar branch of the saphenous nerve during hamstring tendon harvesting: A meta-analysis.

PubMed

Pękala, Przemysław A; Tomaszewski, Krzysztof A; Henry, Brandon Michael; Ramakrishnan, Piravin Kumar; Roy, Joyeeta; Mizia, Ewa; Walocha, Jerzy A

2017-11-01

Our goal was to conduct a comprehensive analysis of studies reporting data on the rate of injury to the infrapatellar branch of the saphenous nerve following hamstring tendon graft harvesting with respect to the type of incision over the pes anserinus. A broad search through all major electronic databases was conducted to identify articles eligible for inclusion. All available data were extracted and pooled into the analysis. Eleven studies (n = 1,050 patients) were included in the meta-analysis. The study revealed that a vertical incision during hamstring tendon harvesting over the pes anserinus was associated with the highest rate of injury with a pooled rate of 51.4% (95% confidence interval [CI], 34.6-67.2%). This was followed by oblique and horizontal incisions with pooled rates of 26.0% (95% CI,1.3-61.3%) and 22.4% (95% CI, 5.4-45.5%), respectively. We highly recommend the use of the shortest possible oblique incision during hamstring tendon harvesting over the pes anserinus. Muscle Nerve 56: 930-937, 2017. © 2017 Wiley Periodicals, Inc.

Surgical repair of chronic patellar tendon rupture in total knee replacement with ipsilateral hamstring tendons.

PubMed

Spoliti, Marco; Giai Via, Alessio; Padulo, Johnny; Oliva, Francesco; Del Buono, Angelo; Maffulli, Nicola

2016-10-01

Patellar tendon rupture is a serious complication of total knee arthroplasty (TKA). Its reconstruction in patients with chronic ruptures is technically demanding. This article reports the results of surgical reconstruction of neglected patellar tendon rupture in TKA using autologous hamstring tendons. Nine TKA patients (six women and three men) (mean age at index surgery 68 years) with chronic patellar tendon tears underwent reconstruction with ipsilateral hamstrings tendon, leaving the distal insertion in situ. The clinical diagnosis was supported by imaging (anterior-posterior and 30° flexion lateral radiographs). Insall-Salvati index, range of motion, and leg extension test were recorded preoperatively and at last follow-up. The modified Cincinnati rating system and the Kujala score were administered. The patients sustained the patellar tendon tear an average of 8 weeks before the procedure. At final follow-up of 4 years (range 2-8 years), the median of extension lag was 5° (range 0°-15°; DS = 5). The median of post-operative Insall-Salvati index was 1.4 (range 1.3-1.8; SD = 0.15; p = 0.002) compared to the preoperative index of 1.7 (range 1.5-2.2; SD = 0.23). The mean modified Cincinnati and Kujala scores significantly increased compared with the preoperative ones (p < 0.01). At final follow-up, all patients were able to walk without brace or aids, and they were satisfied with the procedure. Based on our retrospective study of nine patients, reconstruction of neglected patellar tendon rupture in TKA with autologous hamstring tendons is feasible and safe, and provides good functional recovery. Case series, Level IV.

Inducement of tissue regeneration of harvested hamstring tendons in a rabbit model

PubMed Central

Soejima, T.; Murakami, H.; Noguchi, K.; Shiba, N.; Nagata, K.

2016-01-01

Objectives The objective of this study was to determine if the use of fascia lata as a tendon regeneration guide (placed into the tendon canal following harvesting the semitendinosus tendon) would improve the incidence of tissue regeneration and prevent fatty degeneration of the semitendinosus muscle. Materials and Methods Bilateral semitendinosus tendons were harvested from rabbits using a tendon stripper. On the inducing graft (IG) side, the tendon canal and semitendinosus tibial attachment site were connected by the fascia lata, which was harvested at the same width as the semitendinosus tendon. On the control side, no special procedures were performed. Two groups of six rabbits were killed at post-operative weeks 4 and 8, respectively. In addition, three healthy rabbits were killed to obtain normal tissue. We evaluated the incidence of tendon tissue regeneration, cross-sectional area of the regenerated tendon tissue and proportion of fatty tissue in the semitendinosus muscle. Results At post-operative week 8, the distal end of the regenerated tissue reached the vicinity of the tibial insertion on the control side in two of six specimens. On the IG side, the regenerated tissue maintained continuity with the tibial insertion in all specimens. The cross-sectional area of the IG side was significantly greater than that of the control side. The proportion of fatty tissue in the semitendinosus muscle on the IG side was comparable with that of the control side, but was significantly greater than that of the normal muscle. Conclusions Tendon tissue regenerated with the fascia lata graft was thicker than naturally occurring regenerated tissue. However, the proportion of fatty tissue in the semitendinosus muscle was greater than that of normal muscle. Cite this article: K. Tabuchi, T. Soejima, H. Murakami, K. Noguchi, N. Shiba, K. Nagata. Inducement of tissue regeneration of harvested hamstring tendons in a rabbit model. Bone Joint Res 2016;5:247–252. DOI: 10

Role of anthropometric data in the prediction of 4-stranded hamstring graft size in anterior cruciate ligament reconstruction.

PubMed

Ho, Sean Wei Loong; Tan, Teong Jin Lester; Lee, Keng Thiam

2016-03-01

To evaluate whether pre-operative anthropometric data can predict the optimal diameter and length of hamstring tendon autograft for anterior cruciate ligament (ACL) reconstruction. This was a cohort study that involved 169 patients who underwent single-bundle ACL reconstruction (single surgeon) with 4-stranded MM Gracilis and MM Semi-Tendinosus autografts. Height, weight, body mass index (BMI), gender, race, age and -smoking status were recorded pre-operatively. Intra-operatively, the diameter and functional length of the 4-stranded autograft was recorded. Multiple regression analysis was used to determine the relationship between the anthropometric measurements and the length and diameter of the implanted autografts. The strongest correlation between 4-stranded hamstring autograft diameter was height and weight. This correlation was stronger in females than males. BMI had a moderate correlation with the diameter of the graft in females. Females had a significantly smaller graft both in diameter and length when compared with males. Linear regression models did not show any significant correlation between hamstring autograft length with height and weight (p>0.05). Simple regression analysis demonstrated that height and weight can be used to predict hamstring graft diameter. The following regression equation was obtained for females: Graft diameter=0.012+0.034*Height+0.026*Weight (R2=0.358, p=0.004) The following regression equation was obtained for males: Graft diameter=5.130+0.012*Height+0.007*Weight (R2=0.086, p=0.002). Pre-operative anthropometric data has a positive correlation with the diameter of 4 stranded hamstring autografts but no significant correlation with the length. This data can be utilised to predict the autograft diameter and may be useful for pre-operative planning and patient counseling for graft selection.

Tendon Healing in Bone Tunnel after Human Anterior Cruciate Ligament Reconstruction: A Systematic Review of Histological Results.

PubMed

Lu, Hongbin; Chen, Can; Xie, Shanshan; Tang, Yifu; Qu, Jin

2018-05-21

Most studies concerning to tendon healing and incorporation into bone are mainly based on animal studies due to the invasive nature of the biopsy procedure. The evidence considering tendon graft healing to bone in humans is limited in several case series or case reports, and therefore, it is difficult to understand the healing process. A computerized search using relevant search terms was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases, as well as a manual search of reference lists. Searches were limited to studies that investigated tendon graft healing to bone by histologic examination after anterior cruciate ligament (ACL) reconstruction with hamstring. Ten studies were determined to be eligible for this systematic review. Thirty-seven cases were extracted from the included studies. Most studies showed that a fibrovascular interface would form at the tendon-bone interface at the early stage and a fibrous indirect interface with Sharpey-like fibers would be expected at the later stage. Cartilage-like tissue at tendon graft-bone interface was reported in three studies. Tendon graft failed to integrate with the surrounding bone in 10 of the 37 cases. Unexpectedly, suspensory type of fixation was used for the above failure cases. An indirect type of insertion with Sharpey-like fibers at tendon-bone interface could be expected after ACL reconstruction with hamstring. Regional cartilage-like tissue may form at tendon-bone interface occasionally. The underlying tendon-to-bone healing process is far from understood in the human hamstring ACL reconstruction. Further human studies are highly needed to understand tendon graft healing in bone tunnel after hamstring ACL reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction.

PubMed

Todor, Adrian; Caterev, Sergiu; Nistor, Dan Viorel; Khallouki, Youssef

2016-06-01

The most commonly used autografts for anterior cruciate ligament reconstruction are the bone-patellar tendon-bone and hamstring tendons. Each has its advantages and limitations. The bone-patellar tendon-bone autograft can lead to more donor-site morbidity, and the hamstring autograft can be unpredictable in size. The quadriceps tendon, with or without a bone block, has been described as an alternative graft source and has been used especially in revision cases, but in recent years, it has attracted attention even for primary cases. We report a technique for harvesting a free bone quadriceps tendon graft and attaching an extracortical button for femoral fixation for anterior cruciate ligament reconstruction.

Is height the best predictor for adequacy of semitendinosus-alone anterior cruciate ligament reconstruction? A study of hamstring graft dimensions and anthropometric measurements.

PubMed

Sundararajan, S R; Rajagopalakrishnan, Ramakanth; Rajasekaran, S

2016-05-01

To predict adequacy of semitendinosus (ST) graft dimension for ACLR from anthropometric measures. Single tendon harvest for autograft hamstring ACLR could be beneficial to limit donor site morbidity; however, concerns for reconstruction failure based upon inadequate graft size may limit this surgical technique. To predict adequacy, prospectively, 108 patients who underwent ACLR by hamstring graft (STG graft) were enrolled for the study. Mean age was 33.028 years ± 9.539 SD (14-59) with 88 males and 20 females. Anthropometric measurements (height, weight, BMI, thigh and total limb length) and intraoperative data (graft dimensions and bone tunnel measurements) were collected for analysis. Semitendinosus graft can be used as 3-strand (ST3) or 4-strand (ST4) graft. Adequacy criteria for ST3 and ST4 graft dimensions were determined from data analysis. SPSS (v.17) Pearson's correlation coefficient and ROC curves were used for statistical analyses. A total of 74 out of 108 patients (68.52 %) had adequate graft dimensions for ST3 reconstruction. Height equal or greater than 158 cm was predictive of adequate graft for ST3 reconstruction. Only 23 patients (21.3 %) had adequate graft dimensions for ST4 reconstruction. Height equal or greater than 170 cm was predictive of adequate graft for ST4 reconstruction. Height variable had the highest ROC curve area of 0.840 and 0.910 for both ST3 graft and ST4 graft, respectively. Hence, height was used as best predictor to determine adequacy of the graft. Height can be predictive of adequate graft for single tendon ACL reconstruction.

Avulsion of the common hamstring tendon origin in an active duty airman.

PubMed

Johnson, Anthony E; Granville, Robert R; DeBerardino, Thomas M

2003-01-01

Hamstring injuries are common in active athletic populations, such as military service members. Ruptures of the hamstring origin from the ischial tuberosity are rare injuries and missed if not considered in the differential diagnosis of ischial pain. Unlike other hamstring injuries, complete hamstring avulsions must be treated surgically. Results of untreated hamstring avulsions are poor. The purpose of this article is to describe the case of an active duty airman who presented for an unrelated complaint and was discovered to have a 5-week-old hamstring avulsion. Surgical repair of the hamstring avulsion 6 weeks after injury yielded an excellent result and return to full duty. Hamstring avulsions recognized early by history and physical examination and diagnostic imaging permits early and effective treatment. Early surgical repair of the tendon to bone can result in return to full duty.

Hamstring Graft Technique for Stabilization of Canine Cranial Cruciate Ligament Deficient Stifles

PubMed Central

LOPEZ, MANDI J.; MARKEL, MARK D.; KALSCHEUR, VICKI; LU, YAN; MANLEY, PAUL A.

2007-01-01

Objective To investigate the harvest and application of hamstring grafts for canine cranial cruciate ligament (CrCL) reconstruction. Study Design Experimental study. Animals Four adult female hounds, weighing 26.3 ± 1.6 kg (mean ± SEM). Methods One stifle in each dog was randomly chosen for hamstring graft CrCL reconstruction after native CrCL transection. Arthroscopy was performed to evaluate graft integrity at 12 weeks. Gait analysis and stifle radiographs were performed preoperatively and up to 52 weeks after graft placement. Dogs were killed 12 (n = 2) or 52 weeks (n = 2) after CrCL reconstruction. Tissues were evaluated grossly and with light and confocal laser microscopy. Results Hamstring grafts were intact in all stifles at 12 weeks (n = 4) and 52 weeks (n = 2). Grossly, there was no osteoarthritis in stifles at 12 weeks and only chondrophytes along the trochlear ridges at 52 weeks. Minimal radiographic evidence of osteoarthritis developed in stifles with grafts during the study. Lameness in limbs with grafts resolved by 52 weeks. Graft tissue was highly vascular, ligamentized, and undergoing active remodeling at 12 weeks. Fifty-two weeks after graft placement, intraarticular graft tissue was well vascularized, mature, and encapsulated by synovium, and graft-bone interfaces were characterized by Sharpey’s fiber insertions. There was no evidence of graft necrosis using confocal laser microscopy at either time point. Conclusions The hamstring graft technique may be a viable method of canine CrCL reconstruction. Clinical Relevance Hamstring grafts may be an alternative technique for canine CrCL reconstruction. Further study is needed before clinical application. PMID:12866003

Angiogenesis in healing autogenous flexor-tendon grafts.

PubMed

Gelberman, R H; Chu, C R; Williams, C S; Seiler, J G; Amiel, D

1992-09-01

On the basis of recent evidence that flexor tendon grafts may heal without the ingrowth of vascular adhesions, eighteen autogenous donor tendons of intrasynovial and extrasynovial origin were transferred to the synovial sheaths in the forepaws of nine dogs, and controlled passive mobilization was instituted early in the postoperative period. The angiogenic responses of the tendon grafts were determined with perfusion studies with India ink followed by cleaing of the tissues with the Spalteholz technique at two, four, and six weeks. A consistent pattern of neovascularization was noted in the donor tendons of extrasynovial origin. Vascular adhesions arising from the flexor digitorum superficialis and the tendon sheath enveloped the tendon grafts by two weeks. By six weeks, the vascularity of the tendon grafts of extrasynovial origin appeared completely integrated with that of the surrounding tissues. Examination of cross sections revealed that the segments of tendon had been completely vascularized by obliquely oriented intratendinous vessels. In contrast, the flexor tendon grafts of intrasynovial origin healed without ingrowth of vascular adhesions. Primary intrinsic neovascularization took place from the proximal and, to a lesser extent, distal sites of the sutures. Examination of cross sections revealed vessels extending through the surface layer of the tendon graft, with small vessels penetrating the interior of the tendons at regular intervals.

Modified tendon stripper for obtaining palmaris longus tendon graft.

PubMed

Aköz, T; Altintaş, H; Civelek, B

1999-04-01

Tendon graft harvesting is a challenging part of hand surgery. It is not only a time-consuming procedure but also carries the potential complications associated with it. Various alternatives for this procedure are presented in the literature to overcome these difficulties. In this paper, we are presenting a series of cases in which a newly modified tendon stripper was used for tendon graft harvesting.

Use of Posterior Hamstring Harvest During Anterior Cruciate Ligament Reconstruction in the Pediatric and Adolescent Population.

PubMed

Khanna, Krishn; Janghala, Abhinav; Pandya, Nirav K

2018-06-01

Posterior hamstring harvest has been described in the adult population in a limited fashion, but no study is available describing the use of posterior hamstring harvest in an active pediatric and adolescent cohort. At times, surgeons may be faced with a challenging anterior harvest due to patient anatomic characteristics, particularly the anatomic features and size of the pes tendons. Clinicians need to have multiple harvest approaches at their disposal. Complications with hamstring harvest such as premature graft transection are more problematic in this population due to higher failure rates with allograft tissue. The posterior harvest via its more proximal location may allow for easier tendon identification, visualization of the accessory attachments, and longer preserved tendon length if transection error occurs when the anterior approach is avoided based on surgical technique, patient anatomic characteristics, and surgeon and patient preference. To describe the technique of a posterior hamstring harvest in pediatric and adolescent patients and to analyze complications. Case series; Level of evidence, 4. This study was a retrospective review of a consecutive series of pediatric and adolescent patients who underwent posterior hamstring harvest. During surgery, the patient's leg was abducted and externally rotated to expose the posteromedial aspect of the knee. A 2-cm incision was made overlying the palpable medial hamstring at the popliteal crease. The posterior hamstring tendons were first harvested proximally with an open tendon stripper and distally with a closed stripper. Preoperative, intraoperative, and postoperative findings and complications were analyzed. A total of 214 patients (mean ± SD age, 15.7 ± 4.1 years; range, 8.0-19.8 years) underwent posterior harvest, with a mean ± SD follow-up of 1.83 ± 1.05 years. No complications occurred in our series related to graft harvest-no graft transections, neurovascular injuries, secondary procedures for

Quadriceps Tendon Autograft Medial Patellofemoral Ligament Reconstruction.

PubMed

Fink, Christian; Steensen, Robert; Gföller, Peter; Lawton, Robert

2018-06-01

Critically evaluate the published literature related to quadriceps tendon (QT) medial patellofemoral ligament (MPFL) reconstruction. Hamstring tendon (HT) MPFL reconstruction techniques have been shown to successfully restore patella stability, but complications including patella fracture are reported. Quadriceps tendon (QT) reconstruction techniques with an intact graft pedicle on the patella side have the advantage that patella bone tunnel drilling and fixation are no longer needed, reducing risk of patella fracture. Several QT MPFL reconstruction techniques, including minimally invasive surgical (MIS) approaches, have been published with promising clinical results and fewer complications than with HT techniques. Parallel laboratory studies have shown macroscopic anatomy and biomechanical properties of QT are more similar to native MPFL than hamstring (HS) HT, suggesting QT may more accurately restore native joint kinematics. Quadriceps tendon MPFL reconstruction, via both open and MIS techniques, have promising clinical results and offer valuable alternatives to HS grafts for primary and revision MPFL reconstruction in both children and adults.

A Comparative Study of Clinical Outcomes and Second-Look Arthroscopic Findings between Remnant-Preserving Tibialis Tendon Allograft and Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: Matched-Pair Design.

PubMed

Kim, You Keun; Ahn, Jong Hyun; Yoo, Jae Doo

2017-12-01

This study aimed to compare stability, functional outcome, and second-look arthroscopic findings after anterior cruciate ligament reconstruction between remnant-preserving tibialis tendon allograft and remnant-sacrificing hamstring tendon autograft. We matched two groups (remnant-preserving tibialis tendon allograft group and hamstring tendon autograft group) in terms of demographic characteristics, associated injury, and knee characteristics. Each group consisted of 25 patients. Operation time was longer in the remnant-preserving tibialis tendon allograft group, but there was no significant intergroup difference in stability, clinical outcome, and second-look arthroscopic findings. When an autograft is not feasible in anterior cruciate ligament reconstruction, the remnant-preserving technique can produce comparable results in terms of restoration of function, stability of the knee, and degree of synovium coverage at second-look arthroscopy compared to remnant-sacrificing hamstring autograft.

Ropivacaine alters the mechanical properties of hamstring tendons: In vitro controlled mechanical testing of tendons from living donors.

PubMed

Ollivier, M; Sbihi, J; Sbihi, A; Pithioux, M; Parratte, S; Argenson, J-N

2017-11-01

Intraarticular or periarticular injection of ropivacaine (RI) is an element of current knee surgery practices. The goal of this study was to determine the effects of RI on the mechanical properties of hamstring tendons. We hypothesized that RI would have a detrimental effect on the mechanical properties of periarticular soft tissues METHODS: A tensile test to failure was performed on 120 hamstring tendon segments harvested during ACL reconstruction surgery in 120 patients. Two sets of tensile tests were done. The first evaluated the effect of RI itself on the mechanical properties of tendons: 30 samples were soaked for 1hour in a 2% RI solution and compared to 30 samples soaked in a saline solution (control group). The second evaluated the effect of RI concentration on the mechanical properties of hamstring tendons: 30 samples were soaked for 1hour in a 2% RI solution and 30 samples were soaked in a 7.5% RI solution. In the first test, 29 samples from each group were analyzed as two samples (one in each group) failed at the grip interface. The specimens exposed to 2% RI had lower ultimate tensile strength (Δ=4.4MPa, P=0.001), strain energy (Δ=13MPa, P=0.001) and Young's modulus (Δ=1.6MPa, P=0.02) than the specimens in the control group. There was no significant difference in the strain at failure between groups (Δ=5%, P=0.3). In the second test, one specimen from the 7.5% RI group failed during the preloading and was excluded. There was no significant difference in terms of the load at failure and ultimate tensile stress (Δ=0.45MPa, P=0.6) and strain energy (Δ=0.49MPa, P=0.49) between the two groups. There were significant differences in terms of elongation at failure (Δ=28%, P=0.0003) and Young's modulus (Δ=2.6MPa, P=0.005), with the specimens exposed to 7.5% RI undergoing greater deformation and having a lower Young's modulus. While local RI injections are widely performed in clinical practice, the results of this in vitro study point to short

Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often.

PubMed

Sheean, Andrew J; Musahl, Volker; Slone, Harris S; Xerogeanes, John W; Milinkovic, Danko; Fink, Christian; Hoser, Christian

2018-04-28

Traditional bone-patellar tendon-bone and hamstring tendon ACL grafts are not without limitations. A growing body of anatomic, biomechanical and clinical data has demonstrated the utility of quadriceps tendon autograft in arthroscopic knee ligament reconstruction. The quadriceps tendon autograft provides a robust volume of tissue that can be reliably harvested, mitigating the likelihood of variably sized grafts and obviating the necessity of allograft augmentation. Modern, minimally invasive harvest techniques offer the advantages of low rates of donor site morbidity and residual extensor mechanism strength deficits. New data suggest that quadriceps tendon autograft may possess superior biomechanical characteristics when compared with bone-patella tendon-bone (BPTB) autograft. However, there have been very few direct, prospective comparisons between the clinical outcomes associated with quadriceps tendon autograft and other autograft options (eg, hamstring tendon and bone-patellar tendon-bone). Nevertheless, quadriceps tendon autograft should be one of the primary options in any knee surgeon's armamentarium. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Short medial approach harvesting of hamstring tendons.

PubMed

Lanternier, H; de Cussac, J B; Collet, T

2016-04-01

Harvesting the hamstring tendons for anterior cruciate ligament reconstruction is not straightforward to perform or to teach: the incision is small, the work-space is narrow and the surgeon's tactile feedback using the stripper is difficult to explain to juniors. The purpose of this short note is to describe a reliable means of harvesting the semitendinosus, gracilis or both. Patient and tourniquet positioning, instrumentation and landmarks are detailed; then the 6 steps (speed-bump 1, speed-bump 2, bubble, hook, expansions, stripper) are explained. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Irradiated Hamstring Tendon Allograft Versus Autograft for Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: Midterm Clinical Outcomes.

PubMed

Tian, Shaoqi; Wang, Bin; Liu, Lun; Wang, Yuanhe; Ha, Chengzhi; Li, Qicai; Yang, Xu; Sun, Kang

2016-10-01

Most studies on grafts for anterior cruciate ligament (ACL) reconstruction (ACLR) have been of autografts or nonirradiated allografts with a single-bundle (SB) technique. Outcome reports evaluating anatomic double-bundle (DB) ACLR with a hamstring tendon autograft versus irradiated allograft are rare. To compare the clinical outcomes of arthroscopic anatomic DB ACLR with a hamstring tendon autograft versus irradiated allograft. Randomized controlled trial; Level of evidence, 2. Between 2008 and 2009, a total of 107 patients undergoing arthroscopic DB ACLR were prospectively randomized consecutively into 1 of 2 groups (autograft [Auto] group and irradiated allograft [Ir-Allo] group). All the surgical procedures were performed by the same senior surgeon using the DB reconstruction technique. All irradiated hamstring tendon allografts were sterilized with 2.5 Mrad of irradiation before distribution and were obtained from a single certified tissue bank. Graft fixation on the femoral side was by an Endobutton, and on the tibial side by a bioabsorbable interference screw augmented with a staple. The same rehabilitation protocol was applied to all patients. Before surgery and at a mean of 6.9 years of follow-up, patients were evaluated by the same observer according to objective and subjective clinical evaluations including detailed history, physical examination, radiography, functional knee ligament testing, KT-2000 arthrometer testing, Harner vertical jump and Daniel 1-legged hop tests, Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) standard evaluation form, and Cincinnati knee score. A total of 83 patients (Auto: n = 40 [mean age, 29.2 ± 6.9 years]; Ir-Allo: n = 43 [mean age, 28.6 ± 7.2 years]) fulfilled follow-up and clinical evaluations. No significant differences were found between the 2 groups according to the overall IKDC functional and subjective evaluations as well as testing of activity levels. Significant between

Electromechanical delay of the knee flexor muscles is impaired after harvesting hamstring tendons for anterior cruciate ligament reconstruction.

PubMed

Ristanis, Stavros; Tsepis, Elias; Giotis, Dimitrios; Stergiou, Nicholas; Cerulli, Guiliano; Georgoulis, Anastasios D

2009-11-01

Changes in electromechanical delay during muscle activation are expected when there are substantial alterations in the structural properties of the musculotendinous tissue. In anterior cruciate ligament reconstruction, specific tendons are being harvested for grafts. Thus, there is an associated scar tissue development at the tendon that may affect the corresponding electromechanical delay. This study was conducted to investigate whether harvesting of semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction will affect the electromechanical delay of the knee flexors. Case-control study; Level of evidence, 3. The authors evaluated 12 patients with anterior cruciate ligament reconstruction with a semitendinosus and gracilis autograft, 2 years after the reconstruction, and 12 healthy controls. Each participant performed 4 maximally explosive isometric contractions with a 1-minute break between contractions. The surface electromyographic activity of the biceps femoris and the semitendinosus was recorded from both legs during the contractions. The statistical comparisons revealed significant increases of the electromechanical delay of the anterior cruciate ligament-reconstructed knee for both investigated muscles. Specifically, the electromechanical delay values were increased for both the biceps femoris (P = .029) and the semitendinosus (P = .005) of the reconstructed knee when compared with the intact knee. Comparing the anterior cruciate ligament-reconstructed knee against healthy controls revealed similar significant differences for both muscles (semitendinosus, P = .011; biceps femoris, P = .024). The results showed that harvesting the semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction significantly increased the electromechanical delay of the knee flexors. Increased hamstring electromechanical delay might impair knee safety and performance by modifying the transfer time of muscle tension to the tibia and

Dynamic restraint capacity of the hamstring muscles has important functional implications after anterior cruciate ligament injury and anterior cruciate ligament reconstruction.

PubMed

Bryant, Adam L; Creaby, Mark W; Newton, Robert U; Steele, Julie R

2008-12-01

The purpose of this study was to investigate the relation between knee functionality of anterior cruciate ligament deficient (ACLD) and anterior cruciate ligament reconstruction (ACLR) patients and hamstring antagonist torque generated during resisted knee extension. Cross-sectional. Laboratory based. Male ACLD subjects (n=10) (18-35 y) and 27 matched males who had undergone ACLR (14 patella tendon [PT] grafts and 13 combined semitendinosus/gracilis tendon grafts). Not applicable. Knee functionality was rated (0- to 100-point scale) by using the Cincinnati Knee Rating System. Using electromyography data from the semitendinosus (ST) and biceps femoris muscles, we created a mathematical model to estimate the opposing torque generated by the hamstrings during isokinetic knee extension in 10 degrees intervals from 80 degrees to 10 degrees knee flexion. Pearson product-moment correlations revealed that more functional ACLD subjects generated significantly (P<.05) higher hamstring antagonist torque throughout knee extension. In contrast, more functional PT subjects produced significantly lower hamstring antagonist torque at 80 degrees to 70 degrees knee flexion, whereas no significant associations were found between hamstring antagonist torque and knee functionality for the ST/gracilis tendon subjects. An increased hamstring antagonist torque generated by the more functional ACLD subjects, reflective of increased hamstring contractile force, is thought to represent a protective mechanism to compensate for mechanical instability. The restoration of anterior knee stability through ACLR negates the need for augmented hamstring antagonist torque.

Minimally Invasive Posterior Hamstring Harvest

PubMed Central

Wilson, Trent J.; Lubowitz, James H.

2013-01-01

Autogenous hamstring harvesting for knee ligament reconstruction is a well-established standard. Minimally invasive posterior hamstring harvest is a simple, efficient, reproducible technique for harvest of the semitendinosus or gracilis tendon or both medial hamstring tendons. A 2- to 3-cm longitudinal incision from the popliteal crease proximally, in line with the semitendinosus tendon, is sufficient. The deep fascia is bluntly penetrated, and the tendon or tendons are identified. Adhesions are dissected. Then, an open tendon stripper is used to release the tendon or tendons proximally; a closed, sharp tendon stripper is used to release the tendon or tendons from the pes. Layered, absorbable skin closure is performed, and the skin is covered with a skin sealant, bolster dressing, and plastic adhesive bandage for 2 weeks. PMID:24266003

Allograft Augmentation of Hamstring Autograft for Younger Patients Undergoing Anterior Cruciate Ligament Reconstruction.

PubMed

Jacobs, Cale A; Burnham, Jeremy M; Makhni, Eric; Malempati, Chaitu S; Swart, Eric; Johnson, Darren L

2017-03-01

Younger patients and those with smaller hamstring autograft diameters have been shown to be at significantly greater risk of graft failure after anterior cruciate ligament (ACL) reconstruction. To date, there is no information in the literature about the clinical success and/or cost-effectiveness of increasing graft diameter by augmenting with semitendinosus allograft tissue for younger patients. Hybrid hamstring grafts are a cost-effective treatment option because of a reduced rate of graft failure. Cohort study (economic and decision analysis); Level of evidence, 3. We retrospectively identified patients younger than 18 years who had undergone ACL reconstruction by a single surgeon between 2010 and 2015. During this period, the operating surgeon's graft selection algorithm included the use of bone-patellar tendon-bone (BTB) autografts for the majority of patients younger than 18 years. However, hamstring autografts (hamstring) or hybrid hamstring autografts with allograft augment (hybrid) were used in skeletally immature patients and in those whom the surgeon felt might have greater difficulty with postoperative rehabilitation after BTB graft harvest. Patient demographics, graft type, graft diameter, the time the patient was cleared to return to activity, and the need for secondary surgical procedures were compared between the hamstring and hybrid groups. The clinical results were then used to assess the potential cost-effectiveness of hybrid grafts in this select group of young patients with an ACL injury or reconstruction. This study comprised 88 patients (hamstring group, n = 46; hybrid group, n = 42). The 2 groups did not differ in terms of age, sex, timing of return to activity, or prevalence of skeletally immature patients. Graft diameters were significantly smaller in the hamstring group (7.8 vs 9.9 mm; P < .001), which corresponded with a significantly greater rate of graft failure (13 of 46 [28.3%] vs 5 of 42 [11.9%]; P = .049). As a result of the

Ligamentization of tendon grafts treated with an endogenous preparation rich in growth factors: gross morphology and histology.

PubMed

Sánchez, Mikel; Anitua, Eduardo; Azofra, Juan; Prado, Roberto; Muruzabal, Francisco; Andia, Isabel

2010-04-01

To investigate whether the application of a particular platelet-rich plasma preparation rich in growth factors (PRGF) during anterior cruciate ligament (ACL) surgery gives a potential advantage for better tendon graft ligamentization. This study included 37 volunteers who underwent either conventional (control group, n = 15) or PRGF-assisted (n = 22) ACL reconstruction with an autogenous hamstring and required second-look arthroscopy to remove hardware or loose bodies, treat meniscal tears or plica syndrome, or resect cyclops lesions at 6 to 24 months after ACL surgery. The gross morphologies of the grafts were evaluated on second-look arthroscopy by use of the full arthroscopic score (0 to 4 points) to evaluate graft thickness and apparent tension (0 to 2 points) plus synovial coverage (0 to 2 points). At the same time, biopsy specimens were harvested uniformly from the grafted tendons. In these specimens the histologic transformation of the tendon graft to ACL-like tissue was evaluated by use of the Ligament Tissue Maturity Index, and a score to assess the progression of new connective tissue enveloping the graft was created by use of 3 criteria previously used to characterize changes during ligament healing: cellularity, vascularity, and collagen properties. The overall arthroscopic evaluation of PRGF-treated grafts showed an excellent rating in 57.1% of the knees (score of 4) and a fair rating in 42.9% (score of 2 or 3). In contrast, evaluation of untreated grafts showed an excellent rating in 33.3% of the knees, a fair rating in 46.7%, and a poor rating in 20% (score of 0 or 1). Overall, arthroscopic evaluations were not statistically different between PRGF and control groups (P = .051). PRGF treatment influenced the histologic characteristics of the tendon graft, resulting in tissue that was more mature than in controls (P = .024). Histologically evident newly formed connective tissue enveloping the graft was present in 77.3% of PRGF-treated grafts and 40% of

Variability of United States Online Rehabilitation Protocols for Proximal Hamstring Tendon Repair.

PubMed

Lightsey, Harry M; Kantrowitz, David E; Swindell, Hasani W; Trofa, David P; Ahmad, Christopher S; Lynch, T Sean

2018-02-01

The optimal postoperative rehabilitation protocol following repair of complete proximal hamstring tendon ruptures is the subject of ongoing investigation, with a need for more standardized regimens and evidence-based modalities. To assess the variability across proximal hamstring tendon repair rehabilitation protocols published online by United States (US) orthopaedic teaching programs. Cross-sectional study. Online proximal hamstring physical therapy protocols from US academic orthopaedic programs were reviewed. A web-based search using the search term complete proximal hamstring repair rehabilitation protocol provided an additional 14 protocols. A comprehensive scoring rubric was developed after review of all protocols and was used to assess each protocol for both the presence of various rehabilitation components and the point at which those components were introduced. Of 50 rehabilitation protocols identified, 35 satisfied inclusion criteria and were analyzed. Twenty-five protocols (71%) recommended immediate postoperative bracing: 12 (34%) prescribed knee bracing, 8 (23%) prescribed hip bracing, and 5 (14%) did not specify the type of brace recommended. Fourteen protocols (40%) advised immediate nonweightbearing with crutches, while 16 protocols (46%) permitted immediate toe-touch weightbearing. Advancement to full weightbearing was allowed at a mean of 7.1 weeks (range, 4-12 weeks). Most protocols (80%) recommended gentle knee and hip passive range of motion and active range of motion, starting at a mean 1.4 weeks (range, 0-3 weeks) and 4.0 weeks (range, 0-6 weeks), respectively. However, only 6 protocols (17%) provided specific time points to initiate full hip and knee range of motion: a mean 8.0 weeks (range, 4-12 weeks) and 7.8 weeks (range, 0-12 weeks), respectively. Considerable variability was noted in the inclusion and timing of strengthening, stretching, proprioception, and cardiovascular exercises. Fifteen protocols (43%) required completion of

Inducement of semitendinosus tendon regeneration to the pes anserinus after its harvest for anterior cruciate ligament reconstruction-A new inducer grafting technique

PubMed Central

2012-01-01

Purpose To investigate the usefulness of the “inducer grafting” technique for regeneration of the semitendinosus (ST) tendon after its harvest for anterior cruciate ligament (ACL) reconstruction. Methods Twenty knees of 20 patients (mean age at the time of surgery, 23.1 years) underwent ACL reconstruction with a double bundle autograft using the ST tendon (7 patients) and the ST + the gracilis (G) tendons (13 patients). “Inducer grafting” technique After harvesting the ST tendon, a passing pin with a loop thread is inserted along with the tendon stripper. The passing pin is pulled out from the medial thigh and the loop thread retained. As an inducer graft, the ST tendon branch is used. After the ACL graft has been secured, the inducer graft is sutured to the pes anserinus and the proximal end passed through by pulling the thread out. Then the inducer graft is placed within the tendon canal. The mean follow-up period was 15 months. The presence and morphology of the regenerated ST tendon were examined by MRI. And the isometric hamstring strength was examined at 45°, 90° and 120° of knee flexion. Results One month after the operation in all the patients, MRI demonstrated a low-intensity structure at the anatomical location of the ST, at the level of the superior pole of the patella and the joint line, apparently representing the regenerated ST tendon. Four months after the operation, the distal portion of the regenerated ST tendon had reached the pes anserinus in all patients. Twelve months after the operation, the regenerated ST tendon was hypertrophic in 19 of the 20 patients (95%). The isometric knee flexion torque of the ACL-reconstructed limb was significantly lower at 90° and 120° compared with the contralateral limb. Conclusion These results suggest that the “inducer grafting” technique is able to improve the regeneration rate of the harvested ST tendon and promote hypertrophy of the regenerated ST tendon, extending all the way to the pes

Double-bundle PCL reconstruction using autologous hamstring tendons: outcome with a minimum 2-year follow-up.

PubMed

Cury, Ricardo de Paula Leite; Castro Filho, Rômulo Neves; Sadatsune, Daniel Akira; do Prado, Davi Ribeiro; Gonçalves, Ricardo José Peruzzo; Mestriner, Marcos Barbieri

2017-01-01

To present the outcomes of posterior cruciate ligament (PCL) double-bundle reconstruction using autologous hamstring tendons, with a minimum follow-up of two years. Evaluation of 16 cases of PCL injury that underwent double-bundle reconstruction with autogenous hamstring tendons, between 2011 and 2013. The final sample consisted of 16 patients, 15 men and one woman, with a mean age of 31 years (21-49). The predominant mechanism was motorcycle accident in half of the cases. There was a mean interval of 15 months between the time of lesion and the surgery (three to 52 months). Five lesions were isolated and 11, associated. Clinical evaluation, application of validated scores, and measurements with use of the KT-1000 were performed. The analysis showed a mean preoperative Lysholm score of 50 points (28-87), progressing to 94 points (85-100) postoperatively. The IKDC score also demonstrated improvement. In the preoperative evaluation, four and 12 patients were respectively classified as C (abnormal) and D (very unusual), and in the postoperative evaluation six as A (normal) and ten as B (close to normal). In the post-operative evaluation by KT1000 arthrometer, 13 patients showed difference between 0-2 mm and 3 between 3 and 5 mm, when compared with the contralateral side. Autologous hamstring tendons are a viable option in double-bundle reconstruction of the PCL, with good clinical results in a minimum follow-up of two years.

Mid-term development of hamstring tendon length and velocity after distal femoral extension osteotomy in children with bilateral cerebral palsy: a retrospective cohort study.

PubMed

Salami, Firooz; Wagner, Julia; van Drongelen, Stefan; Klotz, Matthias C M; Dreher, Thomas; Wolf, Sebastian I; Niklasch, Mirjam

2018-03-14

Flexed knee gait can be treated with distal femoral extension osteotomy (DFEO) and additional patellar tendon advancement (PTA) in children with cerebral palsy (CP). This study assesses changes in hamstring muscle tendon length (MTL) and velocity after DFEO (+PTA). Nineteen children (mean age 13y [standard deviation 3y] at surgery) with CP and flexed knee gait who were treated with DFEO (15 limbs) or DFEO+PTA (10 limbs) were retrospectively included in this study. Gait analyses were performed preoperatively (E0), 1 year postoperatively (E1), and for 10 limbs additionally 2 to 5 years postoperatively (E2). Hamstring MTL and velocities were assessed at all examination dates using OpenSim. Hamstring MTL and velocity did not change significantly over time. From E0 to E1, knee flexion in stance improved for both DFEO and DFEO+PTA (p<0.05), knee flexion in swing only improved after DFEO+PTA (p<0.05). The improved knee flexion in stance and swing was maintained at E2. DFEO led to a significant improvement in knee kinematics at E1 which was maintained at E2. DFEO seems to prevent recurrent hamstring tightness but does not lead to lengthened or fastened hamstrings. Distal femoral extension osteotomy (DFEO) does not change hamstring muscle tendon length. DFEO does not change hamstring lengthening velocity. DFEO leads to a significant improvement in knee kinematics. Changes in knee kinematics after DFEO can be maintained at mid-term. DFEO seems to prevent recurrent hamstring tightness. © 2018 Mac Keith Press.

Repair of insertional achilles tendinosis with a bone-quadriceps tendon graft.

PubMed

Philippot, Rémi; Wegrzyn, Julien; Grosclaude, Sophie; Besse, Jean Luc

2010-09-01

While conservative treatment may be successful in most cases, partial rupture at the calcaneal insertion point is a significant concern with insertional Achilles tendinopathy. We report on the outcomes of a surgical technique for Achilles tendon augmentation using a bone-tendon graft harvested from the knee extensor system. Our retrospective case series includes 25 surgical procedures performed in 24 patients, 19 males and five females, with a mean age of 47 (range, 30 to 59) years, 18 of whom were athletes. The mean followup period was 52 (range, 12 to 156) months. All patients underwent MRI examination prior to surgery which showed partial Achilles tendon rupture. The Achilles tendon was debrided through a posterolateral approach. The bone-quadriceps tendon graft was harvested, then the bone plug of the graft was inserted into a blind tunnel drilled into the calcaneus and fixed with an interference screw. The fibers of the quadriceps tendon were sutured to the residual part of the Achilles tendon with the foot at an angle of 90 degrees. Patients were able to resume their sporting activity after an average of 6.7 months. At last followup examination, physical activity was scored 5.2 on the 10-point Tegner Scale; the mean AOFAS score was 98.4. MRI examination showed good graft integration 1 year postoperatively. The bone-quadriceps tendon grafting technique was a good alternative for the insertional Achilles lesions with partial detachment which we felt required augmentation.

Presence of Bacteria in Spontaneous Achilles Tendon Ruptures.

PubMed

Rolf, Christer G; Fu, Sai-Chuen; Hopkins, Chelsea; Luan, Ju; Ip, Margaret; Yung, Shu-Hang; Friman, Göran; Qin, Ling; Chan, Kai-Ming

2017-07-01

The structural pathology of Achilles tendon (AT) ruptures resembles tendinopathy, but the causes remain unknown. Recently, a number of diseases were found to be attributed to bacterial infections, resulting in low-grade inflammation and progressive matrix disturbance. The authors speculate that spontaneous AT ruptures may also be influenced by the presence of bacteria. Bacteria are present in ruptured ATs but not in healthy tendons. Cross-sectional study; Level of evidence, 3. Patients with spontaneous AT ruptures and patients undergoing anterior cruciate ligament (ACL) reconstruction were recruited for this study. During AT surgical repair, excised tendinopathic tissue was collected, and healthy tendon samples were obtained as controls from hamstring tendon grafts used in ACL reconstruction. Half of every sample was reserved for DNA extraction and the other half for histology. Polymerase chain reaction (PCR) was conducted using 16S rRNA gene universal primers, and the PCR products were sequenced for the identification of bacterial species. A histological examination was performed to compare tendinopathic changes in the case and control samples. Five of 20 AT rupture samples were positive for the presence of bacterial DNA, while none of the 23 hamstring tendon samples were positive. Sterile operating and experimental conditions and tests on samples, controlling for harvesting and processing procedures, ruled out the chance of postoperative bacterial contamination. The species identified predominantly belonged to the Staphylococcus genus. AT rupture samples exhibited histopathological features characteristic of tendinopathy, and most healthy hamstring tendon samples displayed normal tendon features. There were no apparent differences in histopathology between the bacterial DNA-positive and bacterial DNA-negative AT rupture samples. The authors have demonstrated the presence of bacterial DNA in ruptured AT samples. It may suggest the potential involvement of bacteria

Over-the-top ACL Reconstruction Plus Extra-articular Lateral Tenodesis With Hamstring Tendon Grafts: Prospective Evaluation With 20-Year Minimum Follow-up.

PubMed

Zaffagnini, Stefano; Marcheggiani Muccioli, Giulio Maria; Grassi, Alberto; Roberti di Sarsina, Tommaso; Raggi, Federico; Signorelli, Cecilia; Urrizola, Francisco; Spinnato, Paolo; Rimondi, Eugenio; Marcacci, Maurilio

2017-12-01

There are few published studies with very long-term follow-up of combined intra- and extra-articular anterior cruciate ligament (ACL) reconstruction. To analyze clinical and radiographic outcomes of over-the-top ACL reconstruction plus extra-articular lateral tenodesis with autologous hamstrings at minimum 20-year follow-up. Case series; Level of evidence, 4. Of 60 originally eligible patients who underwent over-the-top ACL reconstruction with double-stranded hamstring tendon (leaving intact graft tibial insertions) and extra-articular lateral plasty (performed with the remnant part of tendons), 52 were prospectively evaluated at a minimum 20-year follow-up (mean follow-up, 24 years; 41 men, 11 women; mean age at time of surgery, 25.5 ± 7.6 years). Twenty-nine patients were available for prospective evaluations: clinical (Lysholm, Tegner, and objective International Knee Documentation Committee [IKDC]), instrumented (KT-2000), and radiographic (standard, long-standing, and Merchant views). Subjective KOOS (Knee injury and Osteoarthritis Outcome Score) and objective inertial sensor pivot-shift analysis (KiRA) were carried out at final follow-up. Twenty-three patients were investigated by phone interview for subjective Tegner score and documented complications, rerupture, or revision surgery. At final follow-up, mean Lysholm score was 85.7 ± 14.6; median Tegner score, 4 (range, 3-5); sport activity resumption, 86.2%; and objective IKDC score, good or excellent in 86% of patients (31%, A; 55%, B). Only 3 of 26 patients (12%) had >5-mm manual maximum KT-2000 side-to-side difference. KiRA system documented positive pivot-shift (>0.9-m/s 2 tibial acceleration side-to-side difference) in these 3 of 26 patients (12%). Statistically significant changes were as follows: decrease in Tegner score from 7 (range, 6-8) at 5-year follow-up to 4 (range, 3-5) at 10 years ( P < .0001) and decrease in Lysholm score from 96.1 ± 7.3 at 10-year follow-up to 85.7 ± 14.6 at 20 years

Failure Rate and Clinical Outcomes of Anterior Cruciate Ligament Reconstruction Using Autograft Hamstring Versus a Hybrid Graft.

PubMed

Leo, Brian M; Krill, Michael; Barksdale, Leticia; Alvarez-Pinzon, Andres M

2016-11-01

To compare the revision rate and subjective outcome measures of autograft hamstring versus a soft tissue hybrid graft combining both autograft hamstring and tibialis allograft for isolated anterior cruciate ligament (ACL) reconstruction. A single-center retrospective, nonrandomized, comparative study of isolated ACL reconstruction revision rates for subjects who underwent arthroscopic reconstruction of the ACL using autograft hamstring or a soft tissue hybrid graft using both autograft hamstring and tibialis allograft was performed. Patients with isolated ACL tears were included and underwent anatomic single-bundle reconstruction using an independent tunnel drilling technique and a minimum of 24 months' follow-up. The primary outcome assessed was the presence or absence of ACL rerupture. Secondary clinical outcomes consisted of the International Knee Documentation Committee, University of California at Los Angeles (UCLA) ACL quality of life assessment, and the visual analog pain scale. Between February 2010 and April 2013, 95 patients with isolated ACL tears between ages 18 and 40 met the inclusion criteria and were enrolled. Seventy-one autograft hamstring and 24 soft tissue hybrid graft ACL reconstructions were performed during the course of this study. The follow-up period was 24 to 32 months (mean 26.9 months). There were no statistically significant differences in patient demographics or Outerbridge classification. No statistically significant differences in ACL retears (5.6% auto, 4.2% hybrid; P = .57) were found between groups. Clinical International Knee Documentation Committee and UCLA ACL quality of life assessment improvement scores revealed no statistically significant differences in autograft and hybrid graft reconstructions (41 ± 11, 43 ± 13; P = .65) (38 ± 11, 40 ± 10; P = .23). The mean pain level decreased from 8.1 to 2.8 in the autograft group and 7.9 to 2.5 in the hybrid group (P = .18). The use of a hybrid soft tissue graft has a

Infra Patellar Branch of Saphenous Nerve Injury during Hamstring Graft Harvest: Vertical versus Oblique Incisions.

PubMed

Joshi, A; Kayasth, N; Shrestha, S; Kc, B R

2016-09-01

Autologous hamstring grafts are commonly used for anterior cruciate ligament reconstruction. The injury of infrapatellar branch of saphenous nerve is one of the concerns leading to various pattern of sensory loss in the operated leg. An oblique incision to harvest the graft has been reported to be better than the vertical one.The aim of this study was to compare the incidence, recovery of nerve injury and final outcome in patients with hamstring harvest of vertical or oblique incision. A total of 146 patients who underwent hamstring graft harvest for anterior cruciate ligament reconstruction, were included in the study. They were randomized into two (Vertical and Oblique) groups as per the incisions used. The sensory loss along the Infra Patellar Branch of Saphenous Nerve was documented on 3rd day. Recovery of the nerve injury was monitoredat three, six and 12 months follow-ups. At final follow up Tegner Lysholm score and scale was recorded to compare between two groups. The incidence of infrapatellar branch of saphenous nerve injury was 25% in vertical group and 16.36% in oblique group. Recovery of nerve injury started earlier in oblique group compared to vertical group. The mean TegnerLyshom score was not significantly different in both the groups. Oblique incision to harvest hamstring graft has lesser incidence of infrapatellar branch of saphenous nerve injury, recovers earlier and does not have any adverse effect on final outcome compared to the vertical incision.

Arthroscopic single-bundle anterior cruciate ligament reconstruction with six-strand hamstring tendon allograft versus bone-patellar tendon-bone allograft.

PubMed

Dai, Chengliang; Wang, Fei; Wang, Xiaomeng; Wang, Ruipeng; Wang, Shengjie; Tang, Shiyu

2016-09-01

The aim of this study was to compare the clinical outcomes of arthroscopic single-bundle anterior cruciate ligament (ACL) reconstruction with six-strand hamstring tendon (HT) allograft versus bone-patellar tendon-bone (BPTB) allograft. The prospective randomized controlled trial was included 129 patients. Sixty-nine patients received reconstruction with six-strand HT allografts (HT group), whereas 60 patients with BPTB allografts (BPTB group). Outcome assessment included re-rupture findings, International Knee Documentation Committee (IKDC) scores, Lysholm scores, KT-1000 arthrometer, Lachman test, pivot-shift test, range of motion (ROM) and single-leg hop test. At a mean follow-up of 52 months, 113 patients (HT group, 61 patients; BPTB group, 52 patients) completed a minimum 4-year follow-up. Four patients in HT group and six in BPTB group experienced ACL re-rupture (6.2 vs. 10.3 %) and received revision surgery. Significant between-group differences were observed in KT-1000 outcomes and pivot-shift test 1 (1.2 ± 1.5 vs. 1.8 ± 1.3, p = 0.025; positive rate 6.5 vs. 18.9 %, p = 0.036), 2 (1.1 ± 1.4 vs. 1.6 ± 1.2, p = 0.044; 8.1 vs. 20.7 %, p = 0.039), 4 (1.1 ± 1.5 vs. 1.7 ± 1.4, p = 0.031; 9.7 vs. 25 %, p = 0.012) years postoperatively. The outcomes between the two groups were comparable in terms of IKDC scores, Lysholm scores, Lachman test, ROM and single-leg hop test. Six-strand HT allograft achieved superior anteroposterior and rotational stability after single-bundle ACL reconstruction. It is a reasonable graft substitute for ACL reconstruction. II.

Three-Dimensional Bio-Printed Scaffold Sleeves With Mesenchymal Stem Cells for Enhancement of Tendon-to-Bone Healing in Anterior Cruciate Ligament Reconstruction Using Soft-Tissue Tendon Graft.

PubMed

Park, Sin Hyung; Choi, Yeong-Jin; Moon, Sang Won; Lee, Byung Hoon; Shim, Jin-Hyung; Cho, Dong-Woo; Wang, Joon Ho

2018-01-01

To investigate the efficacy of the insertion of 3-dimensional (3D) bio-printed scaffold sleeves seeded with mesenchymal stem cells (MSCs) to enhance osteointegration between the tendon and tunnel bone in anterior cruciate ligament (ACL) reconstruction in a rabbit model. Scaffold sleeves were fabricated by 3D bio-printing. Before ACL reconstruction, MSCs were seeded into the scaffold sleeves. ACL reconstruction with hamstring tendon was performed on both legs of 15 adult rabbits (aged 12 weeks). We implanted 15 bone tunnels with scaffold sleeves with MSCs and implanted another 15 bone tunnels with scaffold sleeves without MSCs before passing the graft. The specimens were harvested at 4, 8, and 12 weeks. H&E staining, immunohistochemical staining of type II collagen, and micro-computed tomography of the tunnel cross-sectional area were evaluated. Histologic assessment was conducted with a histologic scoring system. In the histologic assessment, a smooth bone-to-tendon transition through broad fibrocartilage formation was identified in the treatment group, and the interface zone showed abundant type II collagen production on immunohistochemical staining. Bone-tendon healing histologic scores were significantly higher in the treatment group than in the control group at all time points. Micro-computed tomography at 12 weeks showed smaller tibial (control, 9.4 ± 0.9 mm 2 ; treatment, 5.8 ± 2.9 mm 2 ; P = .044) and femoral (control, 9.6 ± 2.9 mm 2 ; treatment, 6.0 ± 1.0 mm 2 ; P = .03) bone-tunnel areas in the treated group than in the control group. The 3D bio-printed scaffold sleeve with MSCs exhibited excellent results in osteointegration enhancement between the tendon and tunnel bone in ACL reconstruction in a rabbit model. If secure biological healing between the tendon graft and tunnel bone can be induced in the early postoperative period, earlier, more successful rehabilitation may be facilitated. Three-dimensional bio-printed scaffold sleeves with

Anterior cruciate ligament- and hamstring tendon-derived cells: in vitro differential properties of cells involved in ACL reconstruction.

PubMed

Ghebes, Corina Adriana; Kelder, Cindy; Schot, Thomas; Renard, Auke J; Pakvis, Dean F M; Fernandes, Hugo; Saris, Daniel B

2017-04-01

Anterior cruciate ligament (ACL) reconstruction involves the replacement of the torn ligament with a new graft, often a hamstring tendon (HT). Described as similar, the ACL and HT have intrinsic differences related to their distinct anatomical locations. From a cellular perspective, identifying these differences represents a step forward in the search for new cues that enhance recovery after the reconstruction. The purpose of this study was to characterize the phenotype and multilineage potential of ACL- and HT-derived cells. ACL- and HT-derived cells were isolated from tissue harvest from patients undergoing total knee arthroplasty (TKA) or ACL reconstruction. In total, three ACL and three HT donors were investigated. Cell morphology, self-renewal potential (CFU-F), surface marker profiling, expression of tendon/ligament-related markers (PCR) and multilineage potential were analysed for both cell types; both had fibroblast-like morphology and low self-renewal potential. No differences in the expression of tendon/ligament-related genes or a selected set of surface markers were observed between the two cell types. However, differences in their multilineage potential were observed: while ACL-derived cells showed a high potential to differentiate into chondrocytes and adipocytes, but not osteoblasts, HT-derived cells showed poor potential to form adipocytes, chondrocytes and osteoblasts. Our results demonstrated that HT-derived cells have low multilineage potential compared to ACL-derived cells, further highlighting the need for extrinsic signals to fully restore the function of the ACL upon reconstruction. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Hybrid Grafts in Patients Over 40 Years of Age: Comparisons Between Different Age Groups.

PubMed

Nishio, Yusuke; Kondo, Eiji; Onodera, Jun; Onodera, Tomohiro; Yagi, Tomonori; Iwasaki, Norimasa; Yasuda, Kazunori

2018-05-01

Several recent studies have reported that favorable clinical results and a high level of patient satisfaction can generally be obtained with no increased risk of complications after single-bundle anterior cruciate ligament (ACL) reconstruction performed in patients >40 years of age. However, no studies have yet clarified the age-based differences in clinical outcomes after double-bundle reconstruction. To compare clinical outcomes after double-bundle ACL reconstruction using hamstring tendon hybrid grafts between patients in 2 different age groups: ≥40 years and <40 years. Cohort study; Level of evidence, 3. A retrospective study was conducted using 96 patients (48 men, 48 women ; mean age, 37 years) who underwent unilateral ACL reconstruction between 2008 and 2011. These patients were divided into 2 groups: group M included patients ≥40 years of age (n = 40 patients), and group Y included patients <40 years of age (n = 56 patients). All patients underwent the same anatomic double-bundle ACL reconstruction procedure. Clinical outcomes were evaluated at 2 years after surgery. Tunnel enlargement was also evaluated by computed digital radiography at 1 week and 2 years after surgery. Mean postoperative side-to-side differences in anterior laxity were 0.5 ± 1.9 mm and 1.2 ± 1.5 mm in groups M and Y, respectively; there was a significant difference between the 2 groups ( P = .039). There were no significant differences between the groups in Lysholm knee scores, International Knee Documentation Committee (IKDC) scores, or peak muscle torque of the hamstring. On the other hand, peak muscle torque of the quadriceps was significantly lower in group M (81%) than in group Y (89%) ( P = .025). With respect to femoral tunnel enlargement, the posterolateral tunnel in group M was significantly larger than that in group Y on anteroposterior and lateral radiographs ( P = .015 and P = .002, respectively). Equivalent clinical outcomes were seen between the 2 age groups after

Intramuscular tendon involvement on MRI has limited value for predicting time to return to play following acute hamstring injury.

PubMed

van der Made, Anne D; Almusa, Emad; Whiteley, Rod; Hamilton, Bruce; Eirale, Cristiano; van Hellemondt, Frank; Tol, Johannes L

2018-01-01

Hamstring injury with intramuscular tendon involvement is regarded as a serious injury with a delay in return to play (RTP) of more than 50 days and reinjury rates up to 63%. However, this reputation is based on retrospective case series with high risk of bias. Determine whether intramuscular tendon involvement is associated with delayed RTP and elevated rates of reinjury. MRI of male athletes with an acute hamstring injury was obtained within 5 days of injury. Evaluation included standardised MRI scoring and scoring of intramuscular tendon involvement. Time to RTP and reinjury rate were prospectively recorded. Out of 70 included participants, intramuscular tendon disruption was present in 29 (41.4%) injuries. Injuries without intramuscular tendon disruption had a mean time to RTP of 22.2±7.4 days. Injuries with <50%, 50%-99% and 100% disruption of tendon cross-sectional area had a mean time to RTP of 24.0±9.7, 25.3±8.6 and 31.6±10.9 days, respectively. Injuries with full-thickness disruption took longer to RTP compared with injuries without disruption (p=0.025). Longitudinal intramuscular tendon disruption was not significantly associated with time to RTP. Waviness was present in 17 (24.3%) injuries. Mean time to RTP for injuries without and with waviness was 22.6±7.5 and 30.2±10.8 days (p=0.014). There were 11 (15.7%) reinjuries within 12 months, five (17.2%) in the group with intramuscular tendon disruption and six (14.6%) in the group without intramuscular tendon disruption. Time to RTP for injuries with full-thickness disruption of the intramuscular tendon and waviness is significantly longer (by slightly more than 1 week) compared with injuries without intramuscular tendon involvement. However, due to the considerable overlap in time to RTP between groups with and without intramuscular tendon involvement, its clinical significance for the individual athlete is limited. © Article author(s) (or their employer(s) unless otherwise stated in the text

Surgical treatment for partial rupture of the distal biceps tendon using palmaris longus tendon graft: A case report.

PubMed

Ozasa, Yasuhiro; Wada, Takuro; Iba, Kousuke; Yamashita, Toshihiko

2018-03-08

We report a case of a partial rupture of the distal biceps tendon that was surgically treated using a palmaris longus tendon graft. A 58-year-old man complained of increasing pain with resisted elbow flexion and supination in the antecubital fossa. Magnetic resonance imaging revealed the irregularity of a distal attachment of the biceps brachii and peripheral signal changes. We diagnosed a partial rupture of the distal biceps tendon. Because conservative treatment failed, surgical treatment was performed through a single anterior approach. The insertion of the tendon was partially ruptured at the radial tuberosity. After the involved site was debrided, the palmaris longus tendon was grafted with suture anchors to reinforce the remaining tendon. Postoperative immobilization was not performed, and all moves were freed after 3 weeks. At the 6-year postoperative follow-up, the patient no longer experienced pain and returned to his original job without any limitations. Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

The influence of freezing on the tensile strength of tendon grafts : a biomechanical study.

PubMed

Arnout, Nele; Myncke, Jan; Vanlauwe, Johan; Labey, Luc; Lismont, Daniel; Bellemans, Johan

2013-08-01

We investigated the influence of freezing on the tensile strength of fresh frozen tendon grafts. The biomechanical characteristics of tendons that are less commonly used in knee surgery (tibialis anterior, tibialis posterior, peroneus longus and medial and lateral half of Achilles tendons) were compared to those of a semitendinosus and gracilis graft harvested from the same 10 multi-organ donors. All right side tendons constituted the study group and were frozen at -80 degrees C and thawed at room temperature 5 times. All left side tendons were frozen at -80 degrees C and thawed at room temperature once. There were 59 tendons in the control group and 56 in the study group. The looped grafts were clamped at one side using a custom-made freeze clamp and loaded until failure on an Instron 4505 testing machine. The average ultimate failure load was not significantly different between the control and the study group (p > 0.05). The failure load of the medial tendon Achilles was the lowest in both study and control group (p < 0.001). There was no significant difference in maximum stress, maximum displacement, maximum strain and stiffness between the control and study group (p > 0.05). From our study, we conclude that freezing tendons at -80 degrees C and thawing several times does not influence the maximum load, maximum stress, maximum displacement, maximum strain and stiffness. The medial half of the Achilles tendon is clearly the weakest tendon (p < 0.001). These findings show that tendon grafts can be frozen at -80 degrees C and thawed at room temperature several times without altering their biomechanical properties.

Muscle contributions to medial tibiofemoral compartment contact loading following ACL reconstruction using semitendinosus and gracilis tendon grafts.

PubMed

Konrath, Jason M; Saxby, David J; Killen, Bryce A; Pizzolato, Claudio; Vertullo, Christopher J; Barrett, Rod S; Lloyd, David G

2017-01-01

The muscle-tendon properties of the semitendinosus (ST) and gracilis (GR) are substantially altered following tendon harvest for the purpose of anterior cruciate ligament reconstruction (ACLR). This study adopted a musculoskeletal modelling approach to determine how the changes to the ST and GR muscle-tendon properties alter their contribution to medial compartment contact loading within the tibiofemoral joint in post ACLR patients, and the extent to which other muscles compensate under the same external loading conditions during walking, running and sidestep cutting. Motion capture and electromyography (EMG) data from 16 lower extremity muscles were acquired during walking, running and cutting in 25 participants that had undergone an ACLR using a quadruple (ST+GR) hamstring auto-graft. An EMG-driven musculoskeletal model was used to estimate the medial compartment contact loads during the stance phase of each gait task. An adjusted model was then created by altering muscle-tendon properties for the ST and GR to reflect their reported changes following ACLR. Parameters for the other muscles in the model were calibrated to match the experimental joint moments. The medial compartment contact loads for the standard and adjusted models were similar. The combined contributions of ST and GR to medial compartment contact load in the adjusted model were reduced by 26%, 17% and 17% during walking, running and cutting, respectively. These deficits were balanced by increases in the contribution made by the semimembranosus muscle of 33% and 22% during running and cutting, respectively. Alterations to the ST and GR muscle-tendon properties in ACLR patients resulted in reduced contribution to medial compartment contact loads during gait tasks, for which the semimembranosus muscle can compensate.

Analgesia after ACL reconstruction: Hamstring donor-site injection versus intra-articular local anaesthetic injection.

PubMed

Sonnery-Cottet, B; Saithna, A; Azeem, A; Choudja, E; Pic, J B; Cabaton, J; Thaunat, M

2017-04-01

The purpose of this study was to compare hamstring donor-site injection versus intra-articular injection of a local anaesthetic for analgesia after anterior cruciate ligament (ACL) reconstruction. The two methods provide similar pain relief. 158 consecutive patients undergoing ACL hamstring tendon graft reconstruction (semi-tendinosus/gracilis [STG] or four-stranded semi-tendinosus [ST4]) during two periods in 2015 were included. Peripheral nerve block was not performed. At the end of surgery, 20mL of ropivacaine 7.5mg/mL was injected, intra-articularly during the early period (n=79) and into the hamstring donor site during the second period (n=79). Post-operative pain was evaluated subjectively by the patients using a visual analogue scale (VAS). We recorded patient demographics, concomitant surgical procedures, VAS pain scores, rescue analgesic use, time to discharge, and patient satisfaction. VAS pain score, side effects, and patient satisfaction were also recorded during a phone interview on the day after surgery (D1). Mean VAS pain scores were not significantly different between the two groups immediately after surgery (D0) or on D1 (D0: intra-articular, 2.08 and donor site, 1.88; Mann-Whitney P=0.6). Neither were the groups significantly different for rescue analgesic use, patient satisfaction, or quadriceps activation. The same local anaesthetic provides similar pain relief when injected intra-articularly or into the hamstring donor site after hamstring tendon ACL reconstruction (STG or ST4). III, prospective case-control study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Augmentation of Distal Biceps Repair With an Acellular Dermal Graft Restores Native Biomechanical Properties in a Tendon-Deficient Model.

PubMed

Conroy, Christine; Sethi, Paul; Macken, Craig; Wei, David; Kowalsky, Marc; Mirzayan, Raffy; Pauzenberger, Leo; Dyrna, Felix; Obopilwe, Elifho; Mazzocca, Augustus D

2017-07-01

The majority of distal biceps tendon injuries can be repaired in a single procedure. In contrast, complete chronic tears with severe tendon substance deficiency and retraction often require tendon graft augmentation. In cases with extensive partial tears of the distal biceps, a human dermal allograft may be used as an alternative to restore tendon thickness and biomechanical integrity. Dermal graft augmentation will improve load to failure compared with nonaugmented repair in a tendon-deficient model. Controlled laboratory study. Thirty-six matched specimens were organized into 1 of 4 groups: native tendon, native tendon with dermal graft augmentation, tendon with an attritional defect, and tendon with an attritional defect repaired with a graft. To mimic a chronic attritional biceps lesion, a defect was created by a complete tear, leaving 30% of the tendon's width intact. The repair technique in all groups consisted of cortical button and interference screw fixation. All specimens underwent cyclical loading for 3000 cycles and were then tested to failure; gap formation and peak load at failure were documented. The mean (±SD) load to failure (320.9 ± 49.1 N vs 348.8 ± 77.6 N, respectively; P = .38) and gap formation (displacement) (1.8 ± 1.4 mm vs 1.6 ± 1.1 mm, respectively; P = .38) did not differ between the native tendon groups with and without graft augmentation. In the tendon-deficient model, the mean load to failure was significantly improved with graft augmentation compared with no graft augmentation (282.1 ± 83.8 N vs 199.7 ± 45.5 N, respectively; P = .04), while the mean gap formation was significantly reduced (1.2 ± 1.0 mm vs 2.7 ± 1.4 mm, respectively; P = .04). The mean load to failure of the deficient tendon with graft augmentation (282.1 N) compared with the native tendon (348.8 N) was not significantly different ( P = .12). This indicates that the native tendon did not perform differently from the grafted deficient tendon. In a tendon

[Structural Damage to the Hamstring Graft due to Interaction with Fixation Material and its Effect on Biomechanical Properties of ACL Reconstruction].

PubMed

Kautzner, J; Držík, M; Handl, M; Povýšil, C; Kos, P; Trč, T; Havlas, V

2017-01-01

PURPOSE OF THE STUDY Hamstring grafts are commonly used for ACL reconstruction. The purpose of our study is to determine the effects of the suspension fixation compared to graft cross-pinning transfixation, and the effect(s) of structural damage during the preparation of the graft on biomechanical properties of the graft. MATERIAL AND METHODS The design of the study is a cadaveric biomechanical laboratory study. 38 fresh-frozen human hamstring specimens from 19 cadaveric donors were used. The grafts were tested for their loading properties. One half of each specimen was suspended over a 3.3mm pin, the other half was cross-pinned by a 3.3mm pin to simulate the graft cross-pinning technique. Single impact testing was performed and the failure force, elongation and acceleration/deceleration of each graft was recorded and the loading force vs. elongation of the graft specimens was calculated. Results for suspended and cross-pinned grafts were analysed using ANOVA method, comparing the grafts from each donor. RESULTS The ultimate strength of a double-strand gracilis graft was 1287 ± 134 N when suspended over a pin, the strength of a cross-pinned graft was 833 ± 111 N. For double-strand semitendinosus grafts the strengths were 1883 ± 198 and 997 ± 234 N, respectively. Thus, the failure load for the cross-pinning method is only 64.7% or 52.9% for the suspension method. DISCUSSION Structural damage to the graft significantly reduces the graft strength. Also, extensive suturing during preparation of the graft reduces its strength. CONCLUSIONS Fixation methods that do not interfere with the graft's structure should be used to reduce the risk of graft failure. Key words: ACL reconstruction, hamstring graft, biomechanical testing.

Minimally invasive reconstruction of chronic achilles tendon ruptures using the ipsilateral free semitendinosus tendon graft and interference screw fixation.

PubMed

Maffulli, Nicola; Loppini, Mattia; Longo, Umile Giuseppe; Maffulli, Gayle D; Denaro, Vincenzo

2013-05-01

Achilles tendon ruptures represent more than 40% of all tendon ruptures requiring surgical management. About 20% of acute Achilles tendon tears are not diagnosed at the time of injury and become chronic, necessitating more complicated management than fresh injuries. Several techniques for the reconstruction of chronic tears of the Achilles tendon have been described, but the superiority of one technique over the others has not been demonstrated. Mini-invasive reconstruction of the Achilles tendon, with a gap lesion larger than 6 cm, using the ipsilateral free semitendinosus tendon graft will result in improvement of the overall function with a low rate of complications. Case series; Level of evidence, 4. Between 2008 and 2010, the authors prospectively enrolled 28 consecutive patients (21 men and 7 women; median age, 46 years) with chronic closed ruptures of the Achilles tendon who had undergone reconstruction with a free semitendinosus tendon graft. They assessed the Achilles tendon Total Rupture Score (ATRS), maximum calf circumference, and isometric plantarflexion strength before surgery and at the last follow-up. Outcome of surgery and rate of complications were also recorded. The median follow-up after surgery was 31.4 months. The overall result of surgery was excellent/good in 26 (93%) of 28 patients. The ATRS improved from 42 (range, 29-55) to 86 (range, 78-95) (P < .0001). In the operated leg, the maximum calf circumference and isometric plantarflexion strength were significantly improved after surgery (P < .0001); however, their values remained significantly lower than those of the opposite side (P < .0001). All patients were able to walk on tiptoes and returned to their preinjury working occupation. No infections were recorded. Mini-invasive reconstruction of the Achilles tendon, with a gap lesion larger than 6 cm, using the ipsilateral free semitendinosus tendon graft provides a significant improvement of symptoms and function, although calf

A Comparative Animal Study of Tendon Grafts Healing After Remnant-Preserving Versus Conventional Anterior Cruciate Ligament Reconstruction

PubMed Central

Zhang, Lei; Jiang, Kan; Chai, Hao; Zhou, Mei; Bai, Jingping

2016-01-01

Background The aim of this study was to determine if anterior cruciate ligament (ACL) reconstruction by remnant preservation promotes cell proliferation, vascularization, proprioception recovery, and improved biomechanical properties of the tendon grafts. Material/Methods 75 New Zealand rabbits were randomly assigned into the control group (group A), conventional ACL reconstruction group (group B), ACL reconstruction using remnant preservation and graft through remnant sleeve technique group (group C), and ACL reconstruction using remnant preservation and remnant tensioning technique group (group D). The remnant and healing of tendon grafts in groups C and D were observed at 3, 6, and 12 weeks after surgery, and the mRNA expression levels of VEGF, NT-3 and GAP-43 in ACL (group A) or tendon graft samples (groups B, C, and D) were determined by real-time PCR. Tendon graft cell count, microvessel density (MVD), and proprioceptors were determined by H&E staining, CD34, and S-100 immunohistochemical staining. The biomechanical properties of the tendon graft at week 12 in groups B, C, and D were examined by using a tensile strength test. Results Remnant and tendon grafts were not healed at 3, 6, and 12 weeks after the operation in groups C and D. VEGF, NT-3, and GAP-43 mRNA expressions in groups B, C, and D were higher than those in group A (P<0.05), but no significant difference was observed between groups B, C, and D (P>0.05). Furthermore, tendon graft cell count, MVD, proprioception, and biomechanical properties showed no significant differences (P>0.05) among groups B, C, and D at various time points. Conclusions There was no significant difference in cell proliferation, vascularization, proprioception recovery, or biomechanical properties of the tendon grafts between remnant-preserving and conventional ACL reconstruction methods. PMID:27669454

The Effect of Remnant Tissue Preservation in Anatomic Double-Bundle ACL Reconstruction on Knee Stability and Graft Maturation.

PubMed

Takahashi, Tsuneari; Kimura, Masashi; Hagiwara, Keiichi; Ohsawa, Takashi; Takeshita, Katsushi

2018-06-13

Several investigators have developed anterior cruciate ligament reconstructions (ACLR) with remnant tissue preservation (RTP) and have reported better clinical outcomes. However, the effects of RTP remain controversial. To date, no reports have compared both clinical and radiological outcomes of anatomic double-bundle ACLR using the hamstring tendon and outside-in technique with/without RTP. This article evaluates the effectiveness of RTP in ACLR on knee stability and graft maturation. In total, 75 patients with unilateral ACL injury who had undergone anatomic double-bundle ACLR using autografted hamstring tendon either with RTP (Group P, n  = 43) or without (Group N, n  = 32) were enrolled. Clinical scores, pre- and postoperative side-to-side differences (SSDs) obtained using Telos, radiological evaluations of the grafted tendon using the signal/noise quotient (SNQ) measured using magnetic resonance imaging, and arthroscopic evaluations of the grafted tendon were retrospectively compared between the groups. Postoperative SSDs were smaller in the Group P (0.78 ± 1.90 mm) than in the Group N (1.29 ± 2.18 mm); however, this difference was not significant. Comparing two subgroups of the Group P, the SSD was significantly smaller in those with sufficient remnant coverage (-0.56 ± 1.38 mm) than in those without (1.48 ± 1.77 mm) ( p  = 0.019), as well as in the Group N patients ( p  = 0.019). The degree of synovial coverage of the anteromedial ( p  = 0.0064) and posterolateral ( p  = 0.032) bundle grafted tendon at the time of second-look arthroscopy was significantly better in the Group P than in the Group N. SNQ values of ACL grafted tendon at proximal ( p  = 0.049), middle, and distal ( p  = 0.039) one-third in Group P were better than those in Group N. RTP may enhance synovial coverage and maturation of the grafted tendon. Sufficient remnant tissue coverage may contribute to better knee stability. This is a Level

No difference in the graft shift between a round and a rounded rectangular femoral tunnel for anterior cruciate ligament reconstruction: an experimental study.

PubMed

Takata, Yasushi; Nakase, Junsuke; Oshima, Takeshi; Shimozaki, Kengo; Asai, Kazuki; Tsuchiya, Hiroyuki

2018-05-16

We developed a novel technique of creating a rounded rectangular femoral bone tunnel for anatomical, single-bundle, autologous hamstring tendon anterior cruciate ligament (ACL) reconstruction. Although this tunnel has many advantages, its non-circular shape has raised concerns regarding excessive graft shift within the bone tunnel. This study aimed to compare the graft shift between round and rounded rectangular tunnels using a graft diameter tester for simulating the femoral bone tunnel. Seven semitendinosus tendon grafts harvested from fresh-frozen cadavers were prepared by removing all excess soft tissue. The two ends of a double-fold hamstring tendon were sutured using a baseball stitch and then looped over a TightRope (Arthrex Co., Ltd., Naples, Florida, USA) to make a fourfold graft. The diameter of the graft was standardized to 8 mm using a round graft diameter tester. A round and an original rounded rectangular graft diameter tester were used for simulating the respective femoral bone tunnels. The graft was inserted into the tunnel, with the TightRope positioned on the outside of the tunnel. The distal end of the graft was tensioned to 40 N at an angle of 75° to reproduce the most severe graft bending angle. Digital photographs of the tunnel aperture taken at each simulated tunnel and the range of graft shift in the simulated tunnel were analyzed by ImageJ software. Statistical analyses were performed using the Tukey test. P < 0.05 was considered to be significant. There were no significant differences between the round and the rounded rectangular tunnel groups (P > 0.05) in terms of graft shift, gap area, and graft shift ratio. In a simulated ACL reconstruction, there is no difference in the graft shift between a round and a rounded rectangular bone tunnel.

Clinical Outcomes and Return to Sports in Patients with Chronic Achilles Tendon Rupture after Minimally Invasive Reconstruction with Semitendinosus Tendon Graft Transfer.

PubMed

Usuelli, Federico Giuseppe; D'Ambrosi, Riccardo; Manzi, Luigi; Indino, Cristian; Villafañe, Jorge Hugo; Berjano, Pedro

2017-12-01

Objective  The purpose of the study is to evaluate the clinical results and return to sports in patients undergoing reconstruction of the Achilles tendon after minimally invasive reconstruction with semitendinosus tendon graft transfer. Methods  Eight patients underwent surgical reconstruction with a minimally invasive technique and tendon graft augmentation with ipsilateral semitendinosus tendon for chronic Achilles tendon rupture (more than 30 days after the injury and a gap of >6 cm). Patients were evaluated at a minimum follow-up of 24 months after the surgery through the American Orthopaedic Foot and Ankle Society (AOFAS), the Achilles Tendon Total Rupture Scores (ATRS), the Endurance test, the calf circumference of the operated limb, and the contralateral and the eventual return to sports activity performed before the trauma. Results  The mean age at surgery was 50.5 years. Five men and three women underwent the surgery. The average AOFAS was 92, mean Endurance test was 28.1, and the average ATRS was 87. All patients returned to their daily activities, and six out of eight patients have returned to sports activities prior to the accident (two football players, three runners, one tennis player) at a mean of 7.0 (range: 6.7-7.2) months after the surgery. No patient reported complications or reruptures. Conclusion  Our study confirms encouraging results for the treatment of Achilles tendon rupture with a minimally invasive technique with semitendinosus graft augmentation. The technique can be considered safe and allows patients to return to their sports activity. Level of Evidence  Level IV, therapeutic case series.

Arthroscopic Coracoclavicular Ligament Reconstruction Using a Synthetic Polycaprolactone-Based Polyurethane Urea Tendon Graft: A Report of 5 Cases.

PubMed

Ranne, Juha O; Kainonen, Terho U; Lempainen, Lasse L; Kosola, Jussi A; Kajander, Sami A; Niemi, Pekka T

2018-06-01

Several techniques have been introduced to treat acromioclavicular (AC) separation using the semitendinosus tendon as a graft for coracoclavicular (CC) ligament reconstruction. However, the tendon may have been used previously or the patient may not want it harvested. Hence, synthetic tendon transfers have become increasingly popular. Five patients with chronic AC separations were treated. A synthetic polyurethane urea tendon graft (Artelon Tissue Reinforcement [ATR]) was chosen for its ability to partially transform into connective tissue. The patient follow-up period lasted 45 to 60 months. The mean preoperative Constant Score increased from 64.8 to 100 postoperatively. The mean preoperative Simple Shoulder Test increased from 7.2 to 12 postoperatively. The mean postoperative increase of the CC distance was 1.5 mm. The mean expansion of the clavicular drill hole from the original was 2.1 mm. According to the postoperative magnetic resonance imaging, the grafts had healed well and the cross-sections of the grafts were up to 10.5 mm between the coracoid and the clavicle. The synthetic ATR tendon strip was a practical method for reconstructing a torn CC ligament complex. The ATR graft appears promising for future CC ligament reconstructions.

Hydroxyapatite-doped polycaprolactone nanofiber membrane improves tendon-bone interface healing for anterior cruciate ligament reconstruction.

PubMed

Han, Fei; Zhang, Peng; Sun, Yaying; Lin, Chao; Zhao, Peng; Chen, Jiwu

2015-01-01

Hamstring tendon autograft is a routine graft for anterior cruciate ligament (ACL) reconstruction. However, ways of improving the healing between the tendon and bone is often overlooked in clinical practice. This issue can be addressed by using a biomimetic scaffold. Herein, a biomimetic nanofiber membrane of polycaprolactone/nanohydroxyapatite/collagen (PCL/nHAp/Col) is fabricated that mimics the composition of native bone tissue for promoting tendon-bone healing. This membrane has good cytocompatibility, allowing for osteoblast cell adhesion and growth and bone formation. As a result, MC3T3 cells reveal a higher mineralization level in PCL/nHAp/Col membrane compared with PCL membrane alone. Further in vivo studies in ACL reconstruction in a rabbit model shows that PCL/nHAp/Col-wrapped tendon may afford superior tissue integration to nonwrapped tendon in the interface between the tendon and host bone as well as improved mechanical strength. This study shows that PCL/nHAp/Col nanofiber membrane wrapping of autologous tendon is effective for improving tendon healing with host bone in ACL reconstruction.

Bracing can partially limit tibial rotation during stressful activities after anterior crucial ligament reconstruction with a hamstring graft.

PubMed

Giotis, D; Paschos, N K; Zampeli, F; Pappas, E; Mitsionis, G; Georgoulis, A D

2016-09-01

Hamstring graft has substantial differences with BPTB graft regarding initial mechanical strength, healing sequence, and vascularization, which may imply that a different approach during rehabilitation period is required. The purpose of this study was to investigate the influence of knee bracing on tibial rotation in ACL-reconstructed patients with a hamstring autograft during high loading activities. The hypothesis was that there would be a decrease in tibial rotation in the ACL-reconstructed braced knee as compared to the unbraced knee. Twenty male patients having undergone unilateral ACL reconstruction with a semitendinosus/gracilis autograft were assessed. Kinematic data were collected with an eight-camera optoelectronic system during two stressful tasks: (1) descending from a stair and subsequent pivoting; and (2) landing from a platform and subsequent pivoting. In each patient, three different experimental conditions were evaluated: (A) wearing a prophylactic brace (braced condition); (B) wearing a patellofemoral brace (sleeved condition); (C) without brace (unbraced condition). The intact knee without brace served as a control. Tibial rotation was significantly lower in the intact knee compared to all three conditions of the ACL-reconstructed knee (P≤0.01 for both tasks). Presence of a brace or sleeve resulted in lower tibial rotation than in the unbraced condition (p=0.003 for descending/pivot and P=0.0004 for landing/pivot). The braced condition resulted in lower rotation than the sleeved condition for descending/pivoting (P=0.031) while no differences were found for landing/pivoting (P=0.230). Knee bracing limited the excessive tibial rotation during pivoting under high loading activities in ACL-reconstructed knees with a hamstring graft. This partial restoration of normal kinematics may have a potential beneficial effect in patients recovering from ACL reconstruction with a hamstring autograft. Level III, case-control therapeutic study. Copyright �

Risk of Revision Was Not Reduced by a Double-bundle ACL Reconstruction Technique: Results From the Scandinavian Registers.

PubMed

Aga, Cathrine; Kartus, Jüri-Tomas; Lind, Martin; Lygre, Stein Håkon Låstad; Granan, Lars-Petter; Engebretsen, Lars

2017-10-01

Double-bundle anterior cruciate ligament (ACL) reconstruction has demonstrated improved biomechanical properties and moderately better objective outcomes compared with single-bundle reconstructions. This could make an impact on the rerupture rate and reduce the risk of revisions in patients undergoing double-bundle ACL reconstruction compared with patients reconstructed with a traditional single-bundle technique. The National Knee Ligament Registers in Scandinavia provide information that can be used to evaluate the revision outcome after ACL reconstructions. The purposes of the study were (1) to compare the risk of revision between double-bundle and single-bundle reconstructions, reconstructed with autologous hamstring tendon grafts; (2) to compare the risk of revision between double-bundle hamstring tendon and single-bundle bone-patellar tendon-bone autografts; and (3) to compare the hazard ratios for the same two research questions after Cox regression analysis was performed. Data collection of primary ACL reconstructions from the National Knee Ligament Registers in Denmark, Norway, and Sweden from July 1, 2005, to December 31, 2014, was retrospectively analyzed. A total of 60,775 patients were included in the study; 994 patients were reconstructed with double-bundle hamstring tendon grafts, 51,991 with single-bundle hamstring tendon grafts, and 7790 with single-bundle bone-patellar tendon-bone grafts. The double-bundle ACL-reconstructed patients were compared with the two other groups. The risk of revision for each research question was detected by the risk ratio, hazard ratio, and the corresponding 95% confidence intervals. Kaplan-Meier analysis was used to estimate survival at 1, 2, and 5 years for the three different groups. Furthermore, a Cox proportional hazard regression model was applied and the hazard ratios were adjusted for country, age, sex, meniscal or chondral injury, and utilized fixation devices on the femoral and tibial sides. There were no

Synovial Mesenchymal Stem Cells Promote Meniscus Regeneration Augmented by an Autologous Achilles Tendon Graft in a Rat Partial Meniscus Defect Model

PubMed Central

Ozeki, Nobutake; Muneta, Takeshi; Matsuta, Seiya; Koga, Hideyuki; Nakagawa, Yusuke; Mizuno, Mitsuru; Tsuji, Kunikazu; Mabuchi, Yo; Akazawa, Chihiro; Kobayashi, Eiji; Saito, Tomoyuki; Sekiya, Ichiro

2015-01-01

Although meniscus defects and degeneration are strongly correlated with the later development of osteoarthritis, the promise of regenerative medicine strategies is to prevent and/or delay the disease's progression. Meniscal reconstruction has been shown in animal models with tendon grafting and transplantation of mesenchymal stem cells (MSCs); however, these procedures have not shown the same efficacy in clinical studies. Here, our aim was to investigate the ability of tendon grafts pretreated with exogenous synovial-derived MSCs to prevent cartilage degeneration in a rat partial meniscus defect model. We removed the anterior half of the medial meniscus and grafted autologous Achilles tendons with or without a 10-minute pretreatment of the tendon with synovial MSCs. The meniscus and surrounding cartilage were evaluated at 2, 4, and 8 weeks (n = 5). Tendon grafts increased meniscus size irrespective of synovial MSCs. Histological scores for regenerated menisci were better in the tendon + MSC group than in the other two groups at 4 and 8 weeks. Both macroscopic and histological scores for articular cartilage were significantly better in the tendon + MSC group at 8 weeks. Implanted synovial MSCs survived around the grafted tendon and native meniscus integration site by cell tracking assays with luciferase+, LacZ+, DiI+, and/or GFP+ synovial MSCs and/or GFP+ tendons. Flow cytometric analysis showed that transplanted synovial MSCs retained their MSC properties at 7 days and host synovial tissue also contained cells with MSC characteristics. Synovial MSCs promoted meniscus regeneration augmented by autologous Achilles tendon grafts and prevented cartilage degeneration in rats. Stem Cells 2015;33:1927–1938 PMID:25993981

Reconstruction of long digital extensor tendon by cranial tibial muscle fascia graft in a dog.

PubMed

Sabiza, Soroush; Khajeh, Ahmad; Naddaf, Hadi

2016-01-01

Tendon rupture in dogs is generally the result of a direct trauma. This report described the use of adjacent muscle autogenic fascial graft for reconstruction of distal rupture of long digital extensor tendon in a dog. A two-year-old male mix breed dog, was presented with a non-weight bearing lameness of the right hind limb and a deep rupture of lateral side of right tarsus. History taking revealed that this rupture appeared without any apparent cause, when walking around the farm, three days before. Radiography was done and no fracture was observed. Hyperextension of right tarsal joint compared to left limb was observed. Under general anesthesia, after dissections of the ruptured area, complete rupture of long digital extensor tendon was revealed. Then, we attempted to locate the edge of the tendon, however, the tendon length was shortened approximately 1 cm. Hence, a strip of 1 cm length from fascia of cranial tibial muscle was harvested to fill the defect. The graft was sutured to the two ends of tendon using locking loop pattern. Subcutaneous layers and the skin were sutured routinely. Ehmer sling bandage was applied to prevent weight bearing on the surgical region. Re-examination and phone contact with the owner eight weeks and six months postoperatively revealed a poor lameness and excellent function of the dog, respectively. It could be concluded that the fascia of adjacent muscles can be used as an autogenic graft for reconstruction of some tendon ruptures.

Reconstruction of long digital extensor tendon by cranial tibial muscle fascia graft in a dog

PubMed Central

Sabiza, Soroush; Khajeh, Ahmad; Naddaf, Hadi

2016-01-01

Tendon rupture in dogs is generally the result of a direct trauma. This report described the use of adjacent muscle autogenic fascial graft for reconstruction of distal rupture of long digital extensor tendon in a dog. A two-year-old male mix breed dog, was presented with a non-weight bearing lameness of the right hind limb and a deep rupture of lateral side of right tarsus. History taking revealed that this rupture appeared without any apparent cause, when walking around the farm, three days before. Radiography was done and no fracture was observed. Hyperextension of right tarsal joint compared to left limb was observed. Under general anesthesia, after dissections of the ruptured area, complete rupture of long digital extensor tendon was revealed. Then, we attempted to locate the edge of the tendon, however, the tendon length was shortened approximately 1 cm. Hence, a strip of 1 cm length from fascia of cranial tibial muscle was harvested to fill the defect. The graft was sutured to the two ends of tendon using locking loop pattern. Subcutaneous layers and the skin were sutured routinely. Ehmer sling bandage was applied to prevent weight bearing on the surgical region. Re-examination and phone contact with the owner eight weeks and six months postoperatively revealed a poor lameness and excellent function of the dog, respectively. It could be concluded that the fascia of adjacent muscles can be used as an autogenic graft for reconstruction of some tendon ruptures. PMID:27872726

Can Grafts Provide Superior Tendon Healing and Clinical Outcomes After Rotator Cuff Repairs?

PubMed Central

Ono, Yohei; Dávalos Herrera, Diego Alejandro; Woodmass, Jarret M.; Boorman, Richard S.; Thornton, Gail M.; Lo, Ian K. Y.

2016-01-01

Background: Arthroscopic repair of large to massive rotator cuff tears commonly retear. To improve healing rates, a number of different approaches have been utilized, including the use of grafts, which may enhance the biomechanical and biologic aspects of the repair construct. However, the outcomes after the use of grafts are diverse. Purpose: To systematically review the literature for large to massive rotator cuff tears to determine whether the use of grafts generally provides superior tendon healing and clinical outcomes to the repairs without grafts. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review of the literature was performed. Clinical studies comparing the repairs with (graft group) and without grafts (control group) were included and analyzed. The primary outcome was tendon healing on either magnetic resonance imaging or ultrasound. The secondary outcome measures included visual analog scale for pain, University of California at Los Angles (UCLA) score, and forward elevation range. Differences between groups in all outcome measures were statistically analyzed. Results: Six comparative studies (level of evidence 2 or 3) with 13 study groups were included. A total of 242 repairs in the graft group (mean age, 62.5 ± 4.6 years) and 185 repairs in the control group (mean age, 62.5 ± 5.0 years) were analyzed. The graft types utilized included autograft (fascia lata) in 1 study, allograft (human dermis) in 2 studies, xenograft (bovine pericardium, porcine small intestine submucosa) in 2 studies, synthetic graft (polypropylene) in 1 study, and a combination of autograft (the long head of biceps) and synthetic graft (polypropylene) in 1 study. The overall mean follow-up time was 28.4 ± 9.0 months. When 1 or 2 studies/study groups were excluded due to practical or statistical reasons, the graft group demonstrated significantly improved healing (odds ratio, 2.48; 95% CI, 1.58-3.90; P < .0001) and all clinical outcome measures at

Direct Lentiviral-Cyclooxygenase 2 Application to the Tendon-Bone Interface Promotes Osteointegration and Enhances Return of the Pull-Out Tensile Strength of the Tendon Graft in a Rat Model of Biceps Tenodesis

PubMed Central

Wergedal, Jon E.; Stiffel, Virginia; Lau, Kin-Hing William

2014-01-01

This study sought to determine if direct application of the lentiviral (LV)-cyclooxygenase 2 (COX2) vector to the tendon-bone interface would promote osteointegration of the tendon graft in a rat model of biceps tenodesis. The LV-COX2 gene transfer strategy was chosen for investigation because a similar COX2 gene transfer strategy promoted bony bridging of the fracture gap during bone repair, which involves similar histologic transitions that occur in osteointegration. Briefly, a 1.14-mm diameter tunnel was drilled in the mid-groove of the humerus of adult Fischer 344 rats. The LV-COX2 or βgal control vector was applied directly into the bone tunnel and onto the end of the tendon graft, which was then pulled into the bone tunnel. A poly-L-lactide pin was press-fitted into the tunnel as interference fixation. Animals were sacrificed at 3, 5, or 8 weeks for histology analysis of osteointegration. The LV-COX2 gene transfer strategy enhanced neo-chondrogenesis at the tendon-bone interface but with only marginal effect on de novo bone formation. The tendon-bone interface of the LV-COX2-treated tenodesis showed the well-defined tendon-to-fibrocartilage-to-bone histologic transitions that are indicative of osteointegration of the tendon graft. The LV-COX2 in vivo gene transfer strategy also significantly enhanced angiogenesis at the tendon-bone interface. To determine if the increased osteointegration was translated into an improved pull-out mechanical strength property, the pull-out tensile strength of the LV-COX2-treated tendon grafts was determined with a pull-out mechanical testing assay. The LV-COX2 strategy yielded a significant improvement in the return of the pull-out strength of the tendon graft after 8 weeks. In conclusion, the COX2-based in vivo gene transfer strategy enhanced angiogenesis, osteointegration and improved return of the pull-out strength of the tendon graft. Thus, this strategy has great potential to be developed into an effective therapy to

No infections in 1300 anterior cruciate ligament reconstructions with vancomycin pre-soaking of hamstring grafts.

PubMed

Phegan, Michael; Grayson, Jane E; Vertullo, Christopher J

2016-09-01

To investigate the pre-soaking of hamstring grafts in topical vancomycin, in addition to IV prophylaxis, during anterior cruciate ligament (ACL) reconstruction to reduce the incidence of post-operative infection, and to describe an evidence-based diagnostic and treatment algorithm to facilitate early diagnosis and appropriate management of possible knee sepsis post-operatively after ACL reconstruction. This study is a controlled observational series comprising of 1585 individuals who underwent ACL reconstruction over a 13-year period. All surgeries were performed by a single surgeon at the same hospital. Group 1 consisted of 285 patients who received pre-operative IV antibiotics without topical graft pre-soaking. Group 2 consisted of 1300 individuals who received IV antibiotics and graft pre-soaking in a vancomycin solution of 5 mg/mL. In group 1, a total of four patients suffered a post-operative joint infection (1.4 %). Three out of the four were culture positive for Staphylococcus species. The fourth was culture negative but was managed as an acute infection. Group 2 suffered no post-operative infections (0 %). Statistical analysis of the vancomycin pre-soak with IV antibiotics group, compared with IV antibiotics-alone group, revealed a significantly reduced post-operative infection rate using a Fisher's exact test (P = 0.0011) and Chi-square test with Yates' correction (P = 0.0003). Pre-soaking of hamstrings grafts with topical vancomycin reduced the rate of post-operative infection when compared to IV antibiotics alone. This technique should be utilised by surgeons to reduce the overall incidence of knee sepsis post-ACL reconstruction. III.

Modified Weaver-Dunn Procedure Versus The Use of Semitendinosus Autogenous Tendon Graft for Acromioclavicular Joint Reconstruction.

PubMed

Hegazy, Galal; Safwat, Hesham; Seddik, Mahmoud; Al-Shal, Ehab A; Al-Sebai, Ibrahim; Negm, Mohame

2016-01-01

The optimal operative method for acromioclavicular joint reconstruction remains controversial. The modified Weaver-Dunn method is one of the most popular methods. Anatomic reconstruction of coracoclavicular ligaments with autogenous tendon grafts, widely used in treating chronic acromioclavicular joint instability, reportedly diminishes pain, eliminates sequelae, and improves function as well as strength. To compare clinical and radiologic outcomes between a modified Weaver-Dunn procedure and an anatomic coracoclavicular ligaments reconstruction technique using autogenous semitendinosus tendon graft. Twenty patients (mean age, 39 years) with painful, chronic Rockwood type III acromioclavicular joint dislocations were subjected to surgical reconstruction. In ten patients, a modified Weaver-Dunn procedure was performed, in the other ten patients; autogenous semitendinosus tendon graft was used. The mean time between injury and the index procedure was 18 month (range from 9 - 28). Clinical evaluation was performed using the Oxford Shoulder Score and Nottingham Clavicle Score after a mean follow-up time of 27.8 months. Preoperative and postoperative radiographs were compared. In the Weaver-Dunn group the Oxford Shoulder Score improved from 25±4 to 40±2 points. While the Nottingham Clavicle Score increased from 48±7 to 84±11. In semitendinosus tendon graft group, the Oxford Shoulder Score improved from 25±3 points to 50±2 points and the Nottingham Clavicle Score from 48±8 points to 95±8, respectively. Acromioclavicular joint reconstruction using the semitendinosus tendon graft achieved better Oxford Shoulder Score and Nottingham Clavicle Score compared to the modified Weaver-Dunn procedure.

Modified Weaver-Dunn Procedure Versus The Use of Semitendinosus Autogenous Tendon Graft for Acromioclavicular Joint Reconstruction

PubMed Central

Hegazy, Galal; Safwat, Hesham; Seddik, Mahmoud; Al-shal, Ehab A.; Al-Sebai, Ibrahim; Negm, Mohame

2016-01-01

Background: The optimal operative method for acromioclavicular joint reconstruction remains controversial. The modified Weaver-Dunn method is one of the most popular methods. Anatomic reconstruction of coracoclavicular ligaments with autogenous tendon grafts, widely used in treating chronic acromioclavicular joint instability, reportedly diminishes pain, eliminates sequelae, and improves function as well as strength. Objective: To compare clinical and radiologic outcomes between a modified Weaver-Dunn procedure and an anatomic coracoclavicular ligaments reconstruction technique using autogenous semitendinosus tendon graft. Methods: Twenty patients (mean age, 39 years) with painful, chronic Rockwood type III acromioclavicular joint dislocations were subjected to surgical reconstruction. In ten patients, a modified Weaver-Dunn procedure was performed, in the other ten patients; autogenous semitendinosus tendon graft was used. The mean time between injury and the index procedure was 18 month (range from 9 – 28). Clinical evaluation was performed using the Oxford Shoulder Score and Nottingham Clavicle Score after a mean follow-up time of 27.8 months. Preoperative and postoperative radiographs were compared. Results: In the Weaver-Dunn group the Oxford Shoulder Score improved from 25±4 to 40±2 points. While the Nottingham Clavicle Score increased from 48±7 to 84±11. In semitendinosus tendon graft group, the Oxford Shoulder Score improved from 25±3 points to 50±2 points and the Nottingham Clavicle Score from 48±8 points to 95±8, respectively. Conclusion: Acromioclavicular joint reconstruction using the semitendinosus tendon graft achieved better Oxford Shoulder Score and Nottingham Clavicle Score compared to the modified Weaver-Dunn procedure. PMID:27347245

Complications and Adverse Events of a Randomized Clinical Trial Comparing 3 Graft Types for ACL Reconstruction.

PubMed

Mohtadi, Nicholas; Barber, Rhamona; Chan, Denise; Paolucci, Elizabeth Oddone

2016-05-01

Complications/adverse events of anterior cruciate ligament (ACL) surgery are underreported, despite pooled level 1 data in systematic reviews. All adverse events/complications occurring within a 2-year postoperative period after primary ACL reconstruction, as part of a large randomized clinical trial (RCT), were identified and described. Prospective, double-blind randomized clinical trial. Patients and the independent trained examiner were blinded to treatment allocation. University-based orthopedic referral practice. Three hundred thirty patients (14-50 years; 183 males) with isolated ACL deficiency were intraoperatively randomized to ACL reconstruction with 1 autograft type. Graft harvest and arthroscopic portal incisions were identical. Patients were equally distributed to patellar tendon (PT), quadruple-stranded hamstring tendon (HT), and double-bundle (DB) hamstring autograft ACL reconstruction. Adverse events/complications were patient reported, documented, and diagnoses confirmed. Two major complications occurred: pulmonary embolism and septic arthritis. Twenty-four patients (7.3%) required repeat surgery, including 25 separate operations: PT = 7 (6.4%), HT = 9 (8.2%), and DB = 8 (7.3%). Repeat surgery was performed for meniscal tears (3.6%; n = 12), intra-articular scarring (2.7%; n = 9), chondral pathology (0.6%; n = 2), and wound dehiscence (0.3%; n = 1). Other complications included wound problems, sensory nerve damage, muscle tendon injury, tibial periostitis, and suspected meniscal tears and chondral lesions. Overall, more complications occurred in the HT/DB groups (PT = 24; HT = 31; DB = 45), but more PT patients complained of moderate or severe kneeling pain (PT = 17; HT = 9; DB = 4) at 2 years. Overall, ACL reconstructive surgery is safe. Major complications were uncommon. Secondary surgery was necessary 7.3% of the time for complications/adverse events (excluding graft reinjury or revisions) within the first 2 years. Level 1 (therapeutic studies

Examination and Treatment of Hamstring Related Injuries

PubMed Central

2012-01-01

Context: There is a wide spectrum of hamstring-related injuries that can occur in the athlete. Accurate diagnosis is imperative to prevent delayed return to sport, injury recurrence, and accurate clinical decision making regarding the most efficacious treatment. Evidence Acquisition: This review highlights current evidence related to the diagnosis and treatment of hamstring-related injuries in athletes. Data sources were limited to peer-reviewed publications indexed in MEDLINE from 1988 through May 2011. Results: An accurate diagnostic process for athletes with posterior thigh–related complaints should include a detailed and discriminative history, followed by a thorough clinical examination. Diagnostic imaging should be utilized when considering hamstring avulsion or ischial apophyseal avulsion. Diagnostic imaging may also be needed to further define the cause of referred posterior thigh pain. Conclusions: Differentiating acute hamstring strains, hamstring tendon avulsions, ischial apophyseal avulsions, proximal hamstring tendinopathies, and referred posterior thigh pain is critical in determining the most appropriate treatment and expediting safe return to play. PMID:23016076

Twenty-Year Outcome of a Longitudinal Prospective Evaluation of Isolated Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon or Hamstring Autograft.

PubMed

Thompson, Simon Michael; Salmon, Lucy J; Waller, Alison; Linklater, James; Roe, Justin P; Pinczewski, Leo A

2016-12-01

Long-term prospective studies of isolated endoscopic anterior cruciate ligament (ACL) reconstruction are limited and may include confounding factors. This study aimed to compare the outcomes of isolated ACL reconstruction using the patellar tendon (PT) autograft and the hamstring (HT) autograft in 180 patients over 20 years. Cohort study; Level of evidence, 2. A total of 180 participants undergoing isolated ACL reconstruction between 1993 and 1994 were prospectively recruited. Evaluation was performed at 1, 2, 5, 7, 10, 15, and 20 years after surgery and included the International Knee Documentation Committee (IKDC) knee ligament evaluation with radiographic evaluation, KT-1000 arthrometer side-to-side difference, and subjective scores. Over 20 years, there were 16 patients (18%) and 9 patients (10%) with an ACL graft rupture in the HT and PT groups, respectively (P = .13). ACL graft rupture was associated with male sex (odds ratio [OR], 3.9; P = .007), nonideal tunnel position (OR, 3.6; P = .019), and age <18 years at the time of surgery (OR, 4.6; P = .003). The odds of a contralateral ACL rupture were increased in patients with the PT graft compared with patients with the HT graft (OR, 2.2; P = .02) and those aged <18 years at the time of surgery (OR, 3.4; P = .001). The mean IKDC scores at 20-year follow-up were 86 and 89 for the PT and HT groups, respectively (P = .18). At 20 years, 53% and 57% of the PT and HT groups participated in strenuous or very strenuous activities (P = .55), kneeling pain was present in 63% and 20% of the PT and HT groups (P = .018), and radiographic osteoarthritic change was found in 61% and 41% of the PT and HT groups (P = .008), respectively. Compared with patients who received the HT graft, patients who received the PT graft had significantly worse outcomes with regard to radiologically detectable osteoarthritis, kneeling pain, and contralateral ACL injury. At 20-year follow-up, both HT and PT autografts continued to provide good

Anterior cruciate ligament (ACL) autograft reconstruction with hamstring tendons: clinical research among three rehabilitation procedures.

PubMed

Zhu, Weimin; Wang, Daping; Han, Yun; Zhang, Na; Zeng, Yanjun

2013-12-01

To compare the effects of the three rehabilitation procedures following anterior cruciate ligament (ACL) autograft reconstruction with hamstring tendons. An observational and retrospective case-controlled series. The Department of Sports Medicine, Shenzhen Second People Hospital, Shenzhen, PR China. Forty-five patients who were made to undergo ACL reconstructions by using quadrupled semitendinosus and gracilis tendons were divided into three groups: accelerated rehabilitation procedures group, aggressive rehabilitation procedures group, and self-made rehabilitation procedures group. The knee range of motion, thigh perimeter, IKDC score, and bone tunnel diameter in 3D-CT films were evaluated 3 and 6 months and 1 year later. The knee range of motion and thigh perimeter of group A were higher than those of group B and group C at 3, 6, and 12 months. IKDC scores of group C were better than those of groups A and B. The bone tunnel widening with group B was larger than that with groups A and C, and the differences were statistically significant (P < 0.05). Early rehabilitation is beneficial for restoration of knee function after ACL reconstruction. Moderate procedure is better than accelerated procedure.

Gross anatomical and dimensional characteristics of the proximal hamstring origin.

PubMed

Feucht, Matthias J; Plath, Johannes E; Seppel, Gernot; Hinterwimmer, Stefan; Imhoff, Andreas B; Brucker, Peter U

2015-09-01

The current study was undertaken to better define the gross anatomical and dimensional characteristics of the proximal hamstring origin. Twelve paired whole-lower extremities from six embalmed cadavers were dissected. The gross anatomy of the proximal hamstrings was studied. With the tendons attached to the ischial tuberosity, the width and thickness of each tendon was measured 1 cm distally to their origin, and the distance from the most proximal border of the common origin of the semitendinosus (ST) and long head of the biceps (LB) to their distal junction was assessed. After removal of the hamstring group, the shape, orientation, and dimension of the tendon footprints were determined. One cadaver demonstrated unique anatomy, which was considered as an anatomic variant and was therefore excluded from the study group. The ST and LB had a common origin on the posterolateral aspect of the ischial tuberosity (ST/LB), whereas the semimembranosus (SM) had a separated origin at the anterolateral aspect. The mean distance from the most proximal border of the ST/LB origin to the distal junction was 10.0 ± 1.3 cm. The shape of both footprints was longitudinal-oval, with the longitudinal axes of the SM and ST/LB footprints parallel aligned. Mean tendon width was 3.4 ± 0.5 cm for the common ST/LB complex and 4.2 ± 0.9 cm for the SM (p = 0.009). The corresponding values for tendon thickness were 1.0 ± 0.3 cm (ST/LB) and 0.8 ± 0.2 cm (SM), respectively (n.s.). Mean footprint length was 3.9 ± 0.4 cm for ST/LB and 4.5 ± 0.5 cm for SM (p = 0.002). The corresponding values for footprint height were 1.4 ± 0.5 cm (ST/LB) and 1.2 ± 0.3 cm (SM), respectively (n.s.). The ST and LB had a common origin, whereas the SM originated separately. The site of origin of both tendons was the lateral aspect of the ischial tuberosity, with the SM footprint lying directly anterior to the footprint of the ST/LB complex. The footprint of the SM was significantly wider than the footprint of

Proximal hamstring morphology and morphometry in men: an anatomic and MRI investigation.

PubMed

Storey, R N; Meikle, G R; Stringer, M D; Woodley, S J

2016-12-01

The proximal musculo-tendinous junction (MTJ) is a common site of hamstring strain injury but the anatomy of this region is not well defined. A morphometric analysis of the proximal MTJs of biceps femoris long head (BFlh), semitendinosus (ST), and semimembranosus (SM) was undertaken from dissection of 10 thighs from five male cadavers and magnetic resonance imaging of 20 thighs of 10 active young men. The length, volume, and cross-sectional area of the proximal tendon, MTJ and muscle belly, and muscle-tendon interface area were calculated. In both groups, MTJs were reconstructed three-dimensionally. The proximal tendons and MTJs were expansive, particularly within SM and BFlh. Morphology varied between muscles although length measurements within individual muscles were similar in cadavers and young men. Semimembranosus had the longest proximal tendon (cadavers: mean 33.6 ± 2.0 cm; young men: mean 31.7 ± 1.6 cm) and MTJ (>20 cm in both groups) and the greatest muscle-tendon interface area, followed by BFlh and ST. Mean muscle belly volumes were more than three times greater in young men than elderly male cadavers (P < 0.001). These unique morphometric data contribute to a better understanding of hamstring anatomy, an important factor in the pathogenesis of hamstring strain injury. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study With a Mean Follow-up of 3.6 Years.

PubMed

Cavaignac, Etienne; Coulin, Benoit; Tscholl, Philippe; Nik Mohd Fatmy, Nik; Duthon, Victoria; Menetrey, Jacques

2017-05-01

The quadriceps tendon (QT) autograft is known as an effective graft for anterior cruciate ligament (ACL) reconstruction and shows a similar functional outcome to the bone-patellar tendon-bone (BPTB) in randomized controlled trials, with a lesser incidence of complications. Up until now, only 2 studies have compared QT to hamstring tendon (HT) autograft. The functional outcomes of the QT technique are at least as good as those of the HT technique, with the same morbidity. Cohort study; Level of evidence, 3. Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31, 2012. Fifty underwent ACL reconstruction with the QT and 45 with the HT. The same surgical technique, fixation method, and postoperative protocol were used in both groups. The following parameters were evaluated: surgical revisions, functional outcome (Lysholm, Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner, subjective International Knee Documentation Committee), joint stability (KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne-Trumper score), and isokinetic strength. Descriptive statistics are presented for these variables using the Student t test. Eighty-six patients (45 QT, 41 HT) were reviewed with a mean follow-up of 3.6 ± 0.4 years; minimum follow-up was 3 years. There were 4 reoperations in the QT group (including 1 ACL revision) and 3 in the HT group (including 2 ACL revisions) ( P > .05). The Lysholm (89 ± 6.9 vs 83.1 ± 5.3), KOOS Symptoms (90 ± 11.2 vs 81 ± 10.3), and KOOS Sport (82 ± 11.3 vs 67 ± 12.4) scores were significantly better in the QT group than in the HT group. In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements ( P < .005). The negative Lachman component was higher in the QT group than in the HT group (90% vs 46%, P < .005). There was a trend for the negative pivot-shift component to be higher in the QT group

Is quadriceps tendon a better graft choice than patellar tendon? a prospective randomized study.

PubMed

Lund, Bent; Nielsen, Torsten; Faunø, Peter; Christiansen, Svend Erik; Lind, Martin

2014-05-01

The purpose of this randomized controlled study was to compare knee stability, kneeling pain, harvest site pain, sensitivity loss, and subjective clinical outcome after primary anterior cruciate ligament (ACL) reconstruction with either bone-patellar tendon-bone (BPTB) or quadriceps tendon-bone (QTB) autografts in a noninferiority study design. From 2005 to 2009, a total of 51 patients were included in the present study. Inclusion criteria were isolated ACL injuries in adults. Twenty-five patients were randomized to BPTB grafts and 26 to QTB grafts. An independent examiner performed follow-up evaluations 1 and 2 years postoperatively. Anteroposterior knee laxity was measured with a KT-1000 arthrometer (MEDmetric, San Diego, CA). Anterior knee pain was assessed clinically and by knee-walking ability. Knee Injury and Osteoarthritis Outcome Score (KOOS) and subjective International Knee Documentation Committee (IKDC) score were used for patient-evaluated outcome. Anterior knee laxity was equal between the 2 groups with KT-1000 values of 1.1 ± 1.4 mm and 0.8 ± 1.7 mm standard deviation (SD) at follow-up in QTB and BPTB groups, respectively (P = .65), whereas positive pivot shift test results were seen less frequently (14% compared with 38%, respectively; P = .03). Anterior kneeling pain, evaluated by the knee walking ability test, was significantly less in the QTB group, with only 7% of patients grading knee walking as difficult or impossible compared with 34% in the BPTB group. At 1 and 2 years' follow-up, there was no difference between the 2 groups in subjective patient-evaluated outcome. The IKDC score was 75 ± 13 patients and 76 ± 16 SD at 1-year follow-up in QTB and BPTB groups, respectively (P = .78). At 2 years, 12 patients were lost to follow-up, resulting in 18 in the BPTB group and 21 in the QTB group. The use of the QTB graft results in less kneeling pain, graft site pain, and sensitivity loss than seen with BPTB grafts; however, similar anterior knee

[Experimental study of tendon graft fixation in anterior cruciate ligament reconstruction with cortical press-fit bolt in rabbits].

PubMed

Qi, Wei; Li, Chun-bao; Wang, Jun-liang; Zhu, Juan-li; Liu, Yu-jie

2013-05-21

To explore the histological outcomes of tendon-bone healing in anterior cruciate ligament (ACL) reconstruction with cortical press-fit bolt (CPB). Twenty-four healthy female or male New Zealand White rabbits (2-3 months old) underwent bilateral ACL reconstruction with extensor digitorum longus tendon. A random method was used to decide one knee would receive the routine ACL reconstruction (control group) and another cortical press-fit bolt fixation (experimental group). After general anesthesia, extensor digitorum longus tendon was harvested and ACL reconstruction performed. All animals were sacrificed at 4, 8 and 12 weeks postoperation. Radiological and histological examinations were made at each timepoint. The specimens were stained with different methods to observe the pathological changes of tendon graft, bone tunnel and cortical press-fit bolt. More revascularization and massive new bone were found in tendon-bone junction of experimental group at 4, 8 and 12 weeks postoperation. The circum-graft new vessel proportion of the experimental and control groups were 0.48 ± 0.12 and 0.26 ± 0.05 respectively (P < 0.05). In the experimental group, more cartilage cells were present in tendon-bone junction at 12 weeks and the circum-graft new bone areas in two groups were 0.41 ± 0.11 and 0.21 ± 0.10 mm(2) respectively (P < 0.05). Cortical press-fit blot may improve tendon-bone healing after ACL reconstruction in rabbits. The application prospects of this procedure are promising.

Hamstring injuries: prevention and treatment—an update

PubMed Central

Brukner, Peter

2015-01-01

Despite increased knowledge of hamstring muscle injuries, the incidence has not diminished. We now know that not all hamstring injuries are the same and that certain types of injuries require prolonged rehabilitation and return to play. The slow stretch type of injury and injuries involving the central tendon both require longer times to return to play. A number of factors have been proposed as being indicators of time taken to return to play, but the evidence for these is conflicting. Recurrence rates remain high and it is now thought that strength deficits may be an important factor. Strengthening exercise should be performed with the hamstrings in a lengthened position. There is conflicting evidence regarding the efficacy of platelet-rich plasma injection in the treatment of hamstring injuries so at this stage we cannot advise their use. Various tests have been proposed as predictors of hamstring injury and the use of the Nordboard is an interesting addition to the testing process. Prevention of these injuries is the ultimate aim and there is increasing evidence that Nordic hamstring exercises are effective in reducing the incidence. PMID:26105015

Allogeneic versus autologous derived cell sources for use in engineered bone-ligament-bone grafts in sheep anterior cruciate ligament repair.

PubMed

Mahalingam, Vasudevan D; Behbahani-Nejad, Nilofar; Horine, Storm V; Olsen, Tyler J; Smietana, Michael J; Wojtys, Edward M; Wellik, Deneen M; Arruda, Ellen M; Larkin, Lisa M

2015-03-01

The use of autografts versus allografts for anterior cruciate ligament (ACL) reconstruction is controversial. The current popular options for ACL reconstruction are patellar tendon or hamstring autografts, yet advances in allograft technologies have made allogeneic grafts a favorable option for repair tissue. Despite this, the mismatched biomechanical properties and risk of osteoarthritis resulting from the current graft technologies have prompted the investigation of new tissue sources for ACL reconstruction. Previous work by our lab has demonstrated that tissue-engineered bone-ligament-bone (BLB) constructs generated from an allogeneic cell source develop structural and functional properties similar to those of native ACL and vascular and neural structures that exceed those of autologous patellar tendon grafts. In this study, we investigated the effectiveness of our tissue-engineered ligament constructs fabricated from autologous versus allogeneic cell sources. Our preliminary results demonstrate that 6 months postimplantation, our tissue-engineered auto- and allogeneic BLB grafts show similar histological and mechanical outcomes indicating that the autologous grafts are a viable option for ACL reconstruction. These data indicate that our tissue-engineered autologous ligament graft could be used in clinical situations where immune rejection and disease transmission may preclude allograft use.

Synthesis, development, characterization and effectiveness of bovine pure platelet gel-collagen-polydioxanone bioactive graft on tendon healing

PubMed Central

Moshiri, Ali; Oryan, Ahmad; Meimandi-Parizi, Abdolhamid

2015-01-01

Bovine platelet gel (BPG) is an accessible and cost-effective source of growth factors which may have a value in tendon regenerative medicine. We produced a collagen implant (CI) as a tendon proper, covered it with polydioxanone (PDS) sheath to simulate paratenon and finally embedded the BPG as an active source of growth factor within the bioimplant to test whether BPG would be able to accelerate and enhance tendon regeneration and repair. After in vitro characterization of the bioactive grafts, the grafts were implanted in rabbit large tendon defect model. Untreated tendons and tendons treated with either CI or CI-PDS were served as controls for the CI-PDS-BPG. The animals were investigated clinically, ultrasonographically and haematologically for 120 days. After euthanasia, dry matter content, water uptake and delivery characteristics and also gross morphological, histopathological and scanning electron microscopic features of the healing tendons were assessed. In vitro, the activated platelets in the scaffold, released their growth factors significantly more than the controls. BPG also increased cell viability, and enhanced cellular differentiation, maturation and proliferation inside the CI-PDS compared with the controls. In vivo, the BPG modulated inflammation, increased quality and rate of fibroplasia and produced a remodelled tendon that had significantly higher collagen content and superior collagen fibril and fibre differentiation than controls. Treatment also significantly improved tendon water uptake and delivery characteristics, animals’ serum PDGF level, CI-PDS biocompatibility and biodegradability and reduced peritendinous adhesions, muscle fibrosis and atrophy. BPG was effective on tendon healing and CI-PDS-BPG may be a valuable bioscaffold in tendon reconstructive surgery. PMID:25702535

[Tibial press-fit fixation of flexor tendons for reconstruction of the anterior cruciate ligament].

PubMed

Ettinger, M; Liodakis, E; Haasper, C; Hurschler, C; Breitmeier, D; Krettek, C; Jagodzinski, M

2012-09-01

Press-fit fixation of hamstring tendon autografts for anterior cruciate ligament reconstruction is an interesting technique because no hardware is necessary. This study compares the biomechanical properties of press-fit fixations to an interference screw fixation. Twenty-eight human cadaveric knees were used for hamstring tendon explantation. An additional bone block was harvested from the tibia. We used 28 porcine femora for graft fixation. Constructs were cyclically stretched and then loaded until failure. Maximum load to failure, stiffness and elongation during failure testing and cyclic loading were investigated. The maximum load to failure was 970±83 N for the press-fit tape fixation (T), 572±151 N for the bone bridge fixation (TS), 544±109 N for the interference screw fixation (I), 402±77 N for the press-fit suture fixation (S) and 290±74 N for the bone block fixation technique (F). The T fixation had a significantly better maximum load to failure compared to all other techniques (p<0.001). This study demonstrates that a tibial press-fit technique which uses an additional bone block has better maximum load to failure results compared to a simple interference screw fixation.

Articulated Bone Block for Posterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft: Surgical Technique to Facilitate Graft Passage.

PubMed

Cugat, Ramón; Alentorn-Geli, Eduard; Cuscó, Xavier; Navarro, Jordi; Steinbacher, Gilbert; Álvarez-Díaz, Pedro; Seijas, Roberto; Barastegui, David; García-Balletbó, Montse

2018-02-01

Posterior cruciate ligament reconstruction using the transtibial technique provides successful clinical outcomes. However, a bone-patellar tendon-bone (BTB) autograft with the transtibial technique has not been used by some surgeons because of concerns with graft passage from the tibial to the femoral tunnels (sharp turn) that can damage graft fibers. In the present surgical technique, an arthroscopic, transtibial, single-bundle technique for posterior cruciate ligament reconstruction using the BTB autograft with an easy and effective technical tip to facilitate graft passage is presented. Once the BTB is harvested, the femoral bone block is divided into 2 equal-sized blocks providing an articulated structure while preserving the tendon component. This facilitates the passage of the BTB tendon once it is entered in the posterior tibia and the graft has to make a sharp turn to reach the femoral tunnel. This easy and effective technique tip may avoid graft damage during the sharp turn, while maintaining all the advantages of a BTB autograft (bone-to-bone healing, own tissue with fast incorporation, and strong fixation and stability).

Proximal hamstring tendinopathy: results of surgical management and histopathologic findings.

PubMed

Lempainen, Lasse; Sarimo, Janne; Mattila, Kimmo; Vaittinen, Samuli; Orava, Sakari

2009-04-01

Tendon disorders are common problems in sports and are known to be difficult to treat. Only limited information is available concerning treatment of proximal hamstring tendinopathy. To the authors' knowledge, no histopathologic findings of proximal hamstring tendinosis have been published. Surgery (semimembranosus tenotomy and exploration of the sciatic nerve) is an effective treatment for proximal hamstring tendinopathy. Case series; Level of evidence, 4. A total of 103 cases of proximal hamstring tendinopathy in athletes (58 men, 32 women; 13 bilateral operations) with surgical treatment were included. The cases were retrospectively analyzed, and a 4-category rating system was used to evaluate the overall result. At the follow-up, the patients were asked about possible symptoms and their return to sports. Biopsy samples from 15 of the operated tendons were taken and analyzed by a pathologist. The average follow-up was 49 months (range, 12-156 months). The result was evaluated to be excellent in 62 cases, good in 30, fair in 5, and poor in 6. After surgery, 80 of the 90 patients were able to return to the same level of sporting activity as before the onset of the symptoms. This took a mean of 5 months (range, 2-12 months). Typical morphologic findings of tendinosis were found in all biopsy specimens. Given the good functional outcome and low complication rate, the authors present surgical treatment as a valuable option in proximal hamstring tendinopathy if conservative treatment fails.

The effect of platelet-derived growth factors on knee stability after anterior cruciate ligament reconstruction: a prospective randomized clinical study.

PubMed

Vogrin, Matjaz; Rupreht, Mitja; Crnjac, Anton; Dinevski, Dejan; Krajnc, Zmago; Recnik, Gregor

2010-05-01

Arthroscopic reconstruction is a standard surgical procedure in cases of symptomatic knee instability due to rupture of the anterior cruciate ligament. Bone-tendon-bone and hamstring tendon grafts are both in use for anterior cruciate ligament reconstruction. There are no significant differences between the two types of graft in relation to function scores, but there is a difference in anteroposterior stability when measured on the KT-2000 arthrometer: knee joints after reconstruction with bone-tendon-bone autografts are more stable than those reconstructed with hamstring tendon autografts. To improve knee stability after anterior cruciate ligament reconstruction with a hamstring graft and use of platelet-derived growth factors. Platelet-leukocyte gel was produced from platelet-leukocyte-rich plasma prepared from a unit of whole blood in an autologous platelet separator. The gel was applied locally, after hamstring graft placement. Fifty patients were included in the study: 25 in the platelet gel group, 25 in a control group. We evaluated anteroposterior knee stability with the KT-2000 arthrometer before surgery and at 3 and 6 months after surgery. Patients treated with the gel demonstrated significantly better anteroposterior knee stability than patients in the control group. The calculated improvements in knee stability at 6 months were 1.3 +/- 1.8 mm in the control group and 3.1 +/- 2.5 mm in the platelet gel group (P = 0.011). Platelet-leukocyte gel, applied locally, can improve knee stability in surgery for reconstruction of the anterior cruciate ligament.

The Influence of Task Complexity on Knee Joint Kinetics Following ACL Reconstruction

PubMed Central

Schroeder, Megan J.; Krishnan, Chandramouli; Dhaher, Yasin Y.

2015-01-01

Background Previous research indicates that subjects with anterior cruciate ligament reconstruction exhibit abnormal knee joint movement patterns during functional activities like walking. While the sagittal plane mechanics have been studied extensively, less is known about the secondary planes, specifically with regard to more demanding tasks. This study explored the influence of task complexity on functional joint mechanics in the context of graft-specific surgeries. Methods In 25 participants (10 hamstring tendon graft, 6 patellar tendon graft, 9 matched controls), three-dimensional joint torques were calculated using a standard inverse dynamics approach during level walking and stair descent. The stair descent task was separated into two functionally different sub-tasks—step-to-floor and step-to-step. The differences in external knee moment profiles were compared between groups; paired differences between the reconstructed and non-reconstructed knees were also assessed. Findings The reconstructed knees, irrespective of graft type, typically exhibited significantly lower peak knee flexion moments compared to control knees during stair descent, with the differences more pronounced in the step-to-step task. Frontal plane adduction torque deficits were graft-specific and limited to the hamstring tendon knees during the step-to-step task. Internal rotation torque deficits were also primarily limited to the hamstring tendon graft group during stair descent. Collectively, these results suggest that task complexity was a primary driver of differences in joint mechanics between anterior cruciate ligament reconstructed individuals and controls, and such differences were more pronounced in individuals with hamstring tendon grafts. Interpretation The mechanical environment experienced in the cartilage during repetitive, cyclical tasks such as walking and other activities of daily living has been argued to contribute to the development of degenerative changes to the joint

Simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft.

PubMed

Shin, Sang-Jin; Campbell, Sean; Scott, Jonathan; McGarry, Michelle H; Lee, Thay Q

2014-09-01

The purpose of this study was to introduce a novel surgical technique for simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft and to compare its biomechanical characteristics to those of a coracoid cerclage reconstruction of the coracoclavicular ligaments. Six matched pairs of human acromioclavicular joints with an average age of 54.8 ± 7.8 years were used. One shoulder from each pair received the single tendon acromioclavicular-coracoclavicular reconstruction; the contralateral shoulder received the coracoid cerclage reconstruction. Bovine extensor tendon was used for both techniques. The single tendon acromioclavicular-coracoclavicular reconstruction technique provided anatomic restoration of the two coracoclavicular ligaments and the superior and inferior acromioclavicular ligaments simultaneously using one coracoid hole, one acromion hole, and two clavicular holes with interference screws. Anterior-posterior and superior-inferior translations were quantified for all specimens before and after reconstruction, followed by load to failure testing. Following coracoid cerclage reconstruction, total anterior-posterior translation was significantly greater than intact (10.0 ± 5.7 mm; p = 0.008). Following single tendon acromioclavicular-coracoclavicular reconstruction, there was no significant difference in anterior-posterior translation compared to intact (-1.6 ± 2.2 mm; n.s.). The coracoid cerclage technique demonstrated significantly greater anterior-posterior translation than the single tendon acromioclavicular-coracoclavicular technique (p = 0.007). Both techniques restored superior-inferior translation to the intact condition (n.s.). Ultimate load, deformation at ultimate load, and energy absorbed at ultimate load were significantly greater after acromioclavicular-coracoclavicular reconstruction than after coracoid cerclage reconstruction (p < 0.05). This novel single tendon

Hamstring Strength Asymmetry at 3 Years After Anterior Cruciate Ligament Reconstruction Alters Knee Mechanics During Gait and Jogging.

PubMed

Abourezk, Matthew N; Ithurburn, Matthew P; McNally, Michael P; Thoma, Louise M; Briggs, Matthew S; Hewett, Timothy E; Spindler, Kurt P; Kaeding, Christopher C; Schmitt, Laura C

2017-01-01

Anterior cruciate ligament reconstruction (ACLR) using a hamstring tendon autograft often results in hamstring muscle strength asymmetry. However, the effect of hamstring muscle strength asymmetry on knee mechanics has not been reported. Participants with hamstring strength asymmetry would demonstrate altered involved limb knee mechanics during walking and jogging compared with those with more symmetric hamstring strength at least 2 years after ACLR with a hamstring tendon autograft. Controlled laboratory study. There were a total of 45 participants at least 2 years after ACLR (22 male, 23 female; mean time after ACLR, 34.6 months). A limb symmetry index (LSI) was calculated for isometric hamstring strength to subdivide the sample into symmetric hamstring (SH) (LSI ≥90%; n = 18) and asymmetric hamstring (AH) (LSI <85%; n = 18) groups. Involved knee kinematic and kinetic data were collected using 3-dimensional motion analysis during gait and jogging. Peak sagittal-, frontal-, and transverse-plane knee angles and sagittal-plane knee moments and knee powers were calculated. Independent-samples t tests and analyses of covariance were used to compare involved knee kinematic and kinetic variables between the groups. There were no differences in sagittal- and frontal-plane knee angles between the groups ( P > .05 for all). The AH group demonstrated decreased tibial internal rotation during weight acceptance during gait ( P = .01) and increased tibial external rotation during jogging at initial contact ( P = .03) and during weight acceptance ( P = .02) compared with the SH group. In addition, the AH group demonstrated decreased peak negative knee power during midstance ( P = .01) during gait compared with the SH group, after controlling for gait speed, which differed between groups. Participants with hamstring strength asymmetry showed altered involved knee mechanics in the sagittal plane during gait and in the transverse plane during gait and jogging compared with those

Intraoperative extracorporeal autogenous irradiated tendon grafts for functional limb salvage surgery of soft tissue sarcomas of the wrist and hand.

PubMed

Omori, Shinsuke; Hamada, Kenichiro; Outani, Hidetatsu; Oshima, Kazuya; Joyama, Susumu; Tomita, Yasuhiko; Naka, Norifumi; Araki, Nobuhito; Yoshikawa, Hideki

2015-05-12

In patients with soft tissue sarcoma of the wrist and hand, limb salvage operation is extremely challenging for surgeons in attempting a complete tumor resection with negative surgical margins. In this study, we report four patients with soft tissue sarcoma of the wrist and hand treated by limb salvage operation with intraoperative extracorporeal autogenous irradiated tendon grafts. The patients were all male, and the mean age at the time of surgery was 45 years. Histological diagnoses included clear cell sarcoma in two patients, synovial sarcoma in one, and angiosarcoma in one. All four patients had high grade tumors, wherein three had American Joint Committee on Cancer (AJCC) stage III disease and one with AJCC stage IV disease. The tumors were resected en bloc with involved tendons. The tendons were isolated from the resected tissues, irradiated ex vivo, and re-implanted into the host tendons. In one patient, the bone was resected additionally because of tumor invasion to the bone. Hand function was evaluated using Musculoskeletal Tumor Society (MSTS) rating system. Of the four patients, three died of distant metastatic disease. The remaining patient lives and remains disease-free. The mean follow-up period was 33 months. One patient had local recurrence outside the irradiated graft at 20 months after surgery. The functional rating was 22. Lower scores were seen in patients with reconstruction of flexor tendons than extensor tendons. Limb salvage operation with intraoperative extracorporeal autogenous irradiated tendon grafts is an acceptable method in selected patients with soft tissue sarcoma of the wrist and hand.

Long-Term Outcomes of Anterior Cruciate Ligament Reconstruction Using Either Synthetics With Remnant Preservation or Hamstring Autografts: A 10-Year Longitudinal Study.

PubMed

Chen, Tianwu; Zhang, Peng; Chen, Jiwu; Hua, Yinghui; Chen, Shiyi

2017-10-01

The optimal graft choice of anterior cruciate ligament (ACL) reconstruction remains controversial. To compare the outcomes, especially the long-term cumulative failure rate, of ACL reconstruction using either synthetics with remnant preservation or hamstring autografts (4-strand semitendinosus and gracilis tendons). Cohort study; Level of evidence, 2. A total of 133 patients who underwent ACL reconstruction (synthetics: n = 43; hamstring autografts: n = 90) between July 2004 and December 2007 were included. Questionnaires (Tegner activity scale, Lysholm knee scale, and International Knee Documentation Committee [IKDC] subjective form) were completed preoperatively and at 6 months, 1 year, 5 years, and 10 years postoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was additionally applied at 10 years' follow-up. The physical examination was based on the 2000 IKDC form. The manual maximum side-to-side difference (KT-1000 arthrometer), single-hop test, thigh muscle atrophy, and joint degeneration (Kellgren and Lawrence classification) were evaluated. The Kaplan-Meier curve and log-rank test (Mantel-Cox, 95% CI) were used to compare graft survivorship. Ten years postoperatively, 111 patients were available, with 38 (88.4%) patients (mean age, 27.6 ± 9.3 years; 28 men) with synthetics and 73 (81.1%) patients (mean age, 28.6 ± 8.8 years; 64 men) with hamstring autografts. Among them, 104 patients (synthetics: n = 35 [81.4%]; hamstring autografts: n = 69 [76.7%]) completed subjective evaluations, and 89 patients (synthetics: n = 30 [69.8%]; hamstring autografts: n = 59 [65.6%]) completed objective evaluations. For hamstring autografts and synthetics, the cumulative failure rates were 8.2% and 7.9%, respectively, and the log-rank test demonstrated no significant difference between the 2 Kaplan-Meier survival curves ( P = .910). At 6 months postoperatively, for hamstring autografts and synthetics, the mean Lysholm score was 83.0 ± 7.8 and 88.1 ± 7

Rehabilitation and Prevention of Proximal Hamstring Tendinopathy.

PubMed

Beatty, Nicholas R; Félix, Ioonna; Hettler, Jessica; Moley, Peter J; Wyss, James F

Proximal hamstring tendinopathy (PHT) comprises a small but significant portion of hamstring injuries in athletes, especially runners. PHT is a chronic condition that is clinically diagnosed but can be supported with imaging. The main presenting complaint is pain in the lower gluteal or ischial region that may or may not radiate along the hamstrings in the posterior thigh. There is little scientific evidence on which to base the rehabilitation management of PHT. Treatment is almost always conservative, with a focus on activity modification, addressing contributing biomechanical deficiencies, effective tendon loading including eccentric training, and ultrasound-guided interventional procedures which may facilitate rehabilitation. Surgery is limited to recalcitrant cases or those involving concomitant high-grade musculotendinous pathology. The keys to PHT management include early and accurate diagnosis, optimal rehabilitation to allow for a safe return to preinjury activity level, and preventative strategies to reduce risk of reinjury.

A retrospective review of bone tunnel enlargement after anterior cruciate ligament reconstruction with hamstring tendons fixed with a metal round cannulated interference screw in the femur.

PubMed

Kobayashi, Masahiko; Nakagawa, Yasuaki; Suzuki, Takashi; Okudaira, Shuzo; Nakamura, Takashi

2006-10-01

To assess bone tunnel enlargement after anterior cruciate ligament (ACL) reconstruction with the use of hamstring tendons fixed with a round cannulated interference (RCI) screw in the femur. A consecutive series of 30 ACL reconstructions performed with hamstring tendons fixed with an RCI screw in the femur and with staples via Leeds-Keio ligament in the tibia was retrospectively reviewed. The clinical outcome was evaluated through the Lysholm score. Anterior instability was tested by Telos-SE (Telos Japan, Tokyo, Japan) measurement. The location and angle of each femoral and tibial tunnel were measured with the use of plain radiographs, and bone tunnel enlargement greater than 2 mm detected any time 3, 6, 12, and 24 months postoperatively was defined as positive. Each factor (location and angle of the tunnels, sex, affected side, age, Lysholm score, and Telos-SE measurement) was compared between enlarged and nonenlarged groups. Positive enlargement of the bone tunnel (>2.0 mm) was observed in 36.7% (11 of 30) on the femoral side and 33.3% (10 of 30) on the tibial side, and in 6 knees of both sides. Half of patients (15 of 30) had an enlarged tunnel on the femoral or the tibial side until 1 year postoperatively. In most cases, enlargement reached maximum at 6 months postoperatively. Female patients tended to have an enlarged tunnel, especially on the femoral side (P < .05). Tunnel enlargement was not correlated with location and angle of the tunnels. Moreover, no difference was found in Lysholm score and Telos-SE measurement between enlarged and nonenlarged groups, although the nonenlarged group tended to exhibit higher Lysholm score and lesser instability. Bone tunnel enlargement of the femoral or tibial side was observed in half of patients (6 in both sides, 5 only in the femur, and 4 only in the tibia) after ACL reconstruction was performed with a hamstring tendon fixed with an RCI screw. Female patients had a greater chance for enlargement of the femoral tunnel

Expert opinion: diagnosis and treatment of proximal hamstring tendinopathy.

PubMed

Lempainen, Lasse; Johansson, Kristian; Banke, Ingo J; Ranne, Juha; Mäkelä, Keijo; Sarimo, Janne; Niemi, Pekka; Orava, Sakari

2015-01-01

proximal hamstring tendinopathy (PHT) is a disabilitating disease often causing underperformance in the athletically demanding patients. The main symptom of PHT is lower gluteal pain especially during running or while prolonged sitting. Mainly affecting athletically active individuals, PHT is a considerable challenge for treating health care professionals. this paper aims to concisely present the literature on PHT to guide health care professionals treating these patients and doing research on the subject. we reviewed the literature on PHT through literature search of scientific journal databases. as a tendinopathic pathology, it is a rather recently discovered exertion injury. As with other chronic tendon overuse injuries, current treatment strategies are unspecific with uncertain outcomes due to the unknown etiology of the tendon degeneration. Diagnostic features as well as both operative and non-operative treatments are evaluated from a clinical perspective, providing up to date information for clinicians and sports medicine therapists dealing with hamstring problems. V.

Expert opinion: diagnosis and treatment of proximal hamstring tendinopathy

PubMed Central

Lempainen, Lasse; Johansson, Kristian; Banke, Ingo J.; Ranne, Juha; Mäkelä, Keijo; Sarimo, Janne; Niemi, Pekka; Orava, Sakari

2015-01-01

Summary Background: proximal hamstring tendinopathy (PHT) is a disabilitating disease often causing underperformance in the athletically demanding patients. The main symptom of PHT is lower gluteal pain especially during running or while prolonged sitting. Mainly affecting athletically active individuals, PHT is a considerable challenge for treating health care professionals. Purpose: this paper aims to concisely present the literature on PHT to guide health care professionals treating these patients and doing research on the subject. Methods: we reviewed the literature on PHT through literature search of scientific journal databases. Conclusions: as a tendinopathic pathology, it is a rather recently discovered exertion injury. As with other chronic tendon overuse injuries, current treatment strategies are unspecific with uncertain outcomes due to the unknown etiology of the tendon degeneration. Diagnostic features as well as both operative and non-operative treatments are evaluated from a clinical perspective, providing up to date information for clinicians and sports medicine therapists dealing with hamstring problems. Level of evidence: V. PMID:25878983

When the tendon autograft is dropped accidently on the floor: A study about bacterial contamination and antiseptic efficacy.

PubMed

Barbier, O; Danis, J; Versier, G; Ollat, D

2015-10-01

Inadvertent contamination of the autograft can occur during anterior cruciate ligament (ACL) reconstruction if the autograft is dropped on the floor during surgery. A study was undertaken to determine the incidence of contamination when a graft is dropped on the operating room floor and the efficacy of antimicrobial solutions to decontaminate it. Samples from 25 patients undergoing ACL reconstruction with a hamstring tendon were sectioned and dropped onto the floor. Cultures were taken after immersion in antiseptic solutions (a chlorhexidine gluconate solution (group 1), a povidone-iodine solution (group 2), and a sodium hypochlorite solution (group 3)). A fourth piece (group 0) was cultured without being exposed to any solution. Cultures of a floor swab were taken at the same time. The floor swab cultures were positive in 96% of cases. The rate of contamination was 40% in group 0, 8% in group 1, 4% in group 2, and 16% in group 3. There was a significant difference between groups 1 and 2 and group 0 (p<0.05) but not between groups 3 and 0. Immersing a graft dropped on the floor during surgery in a chlorhexidine gluconate solution or povidone-iodine solution significantly reduces contamination of the graft. Soaking of the hamstring autograft in one of these solutions is recommended in the case of inadvertent contamination. Laboratory investigation (level 2). Copyright © 2014 Elsevier B.V. All rights reserved.

Clinical results of hamstring autografts in anterior cruciate ligament reconstruction: a comparison of femoral knot/press-fit fixation and interference screw fixation.

PubMed

Ho, Wei-Pin; Lee, Chian-Her; Huang, Chang-Hung; Chen, Chih-Hwa; Chuang, Tai-Yuan

2014-07-01

To compare the clinical outcomes of femoral knot/press-fit anterior cruciate ligament (ACL) reconstruction with conventional techniques using femoral interference screws. Among patients who underwent arthroscopic ACL reconstruction with hamstring autografts, 73 were treated with either a femoral knot/press-fit technique (40 patients, group A) or femoral interference screw fixation (33 patients, group B). The clinical results of the 2 groups were retrospectively compared. The inclusion criteria were primary ACL reconstruction in active patients. The exclusion criteria were fractures, multiligamentous injuries, patients undergoing revision, or patients with contralateral ACL-deficient knees. In the femoral knot/press-fit technique, semitendinosus and gracilis tendons were prepared as 2 loops with knots. After passage through a bottleneck femoral tunnel, the grafts were fixed with a press-fit method (grafts' knots were stuck in the bottleneck of the femoral tunnel). A tie with Mersilene tape (Ethicon, Somerville, NJ) over a bone bridge for each tendon loop and an additional bioabsorbable interference screw were used for tibial fixation. The mean follow-up period was 38 months (range, 24 to 61 months). A significant improvement in knee function and symptoms was reported in most patients, as shown by improved Tegner scores, Lysholm knee scores, and International Knee Documentation Committee assessments (P < .01). The results of instrumented laxity testing, thigh muscle assessment, and radiologic assessment were clearly improved when compared with the preoperative status (P < .01). No statistically significant difference in outcomes could be observed between group A and group B (P = not significant). In this nonrandomized study, femoral knot/press-fit ACL reconstruction did not appear to provide increased anterior instability compared with that of conventional femoral interference screw ACL reconstruction. Favorable outcomes with regard to knee stability and patient

Acceleration of tendon-bone healing of anterior cruciate ligament graft using intermittent negative pressure in rabbits.

PubMed

Sun, Zhengming; Wang, Xiaoqing; Ling, Ming; Wang, Wei; Chang, Yanhai; Yang, Guang; Dong, Xianghui; Wu, Shixun; Wu, Xueyuan; Yang, Bo; Chen, Ming

2017-04-18

The purpose of this study was to test effects of negative pressure on tendon-bone healing after reconstruction of anterior cruciate ligament (ACL) in rabbits. Hind legs of 24 New Zealand White rabbits were randomly selected as negative pressure group and the contralateral hind legs as control. Reconstruction of the ACL was done. Joints of the negative pressure side were placed with drainage tubes connecting the micro-negative pressure aspirator. Control side was placed with ordinary drainage tubes. Drainage tubes on both sides were removed at the same time 5 days after operation. After 6 weeks, joint fluid was drawn to detect the expression levels of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α); at the same time, femur-ligament-tibia complex was obtained to determine tendon graft tension and to observe the histomorphology, blood vessels of the tendon-bone interface, and expression of vascular endothelial growth factor (VEGF). The maximum load breakage of tendon graft was significantly greater in the negative pressure group than in the control group (P < 0.05). Histological studies of the tendon-bone interface found that there was more new bone formation containing chondroid cells and aligned connective tissue in the negative pressure group than in the control group. Expression of VEGF was higher in the negative pressure group than in the control group (P < 0.01). Content of IL-1β and TNF-α in synovial fluid is lower in the negative pressure group than in the control group (P < 0.01). Intermittent negative pressure plays an active role in tendon-bone healing and creeping substitution of ACL reconstruction in the rabbits.

Elastography Study of Hamstring Behaviors during Passive Stretching

PubMed Central

Le Sant, Guillaume; Ates, Filiz; Brasseur, Jean-Louis; Nordez, Antoine

2015-01-01

Introduction The mechanical properties of hamstring muscles are usually inferred from global passive torque/angle relationships, in combination with adjoining tissues crossing the joint investigated. Shear modulus measurement provides an estimate of changes in muscle-tendon stiffness and passive tension. This study aimed to assess the passive individual behavior of each hamstring muscle in different stretching positions using shear wave elastography. Methods/Results The muscle shear modulus of each hamstring muscle was measured during a standardized slow passive knee extension (PKE, 80% of maximal range of motion) on eighteen healthy male volunteers. Firstly, we assessed the reliability of the measurements. Results were good for semitendinosus (ST, CV: 8.9%-13.4%), semimembranosus (SM, CV: 10.3%-11.2%) and biceps femoris long-head (BF-lh, CV: 8.6%-13.3%), but not for biceps femoris short-head (BF-sh, CV: 20.3%-44.9%). Secondly, we investigated each reliable muscle in three stretch positions: 70°, 90° and 110° of hip flexion. The results showed different values of shear modulus for the same amount of perceived stretch, with the highest measurements in the high-flexed hip situation. Moreover, individual muscles displayed different values, with values increasing or BF-lh, SM and ST, respectively. The inter-subject variability was 35.3% for ST, 27.4% for SM and 30.2% for BF-lh. Conclusion This study showed that the hip needs to be high-flexed to efficiently tension the hamstrings, and reports a higher muscle-tendon stress tolerance at 110° of hip angle. In addition muscles have different passive behaviors, and future works will clarify if it can be linked with rate of injury. PMID:26418862

Ipsilateral free semitendinosus tendon graft with interference screw fixation for minimally invasive reconstruction of chronic tears of the Achilles tendon.

PubMed

Maffulli, N; Del Buono, A; Loppini, M; Denaro, V

2014-10-01

Minimally invasive ipsilateral semitendinosus reconstruction of large chronic tears aims to be advantageous for the patient in terms of plantar flexion recovery, anthropometric measures, fast return to daily and sport activity, is safe, with low donor site co-morbidities, low risks of wound complications and neurovascular injuries. Tendon gaps greater than 6 cm and in cases of revision surgery (rerupture). Diabetes, vascular diseases, previous anterior cruciate ligament (ACL) reconstruction using ipsilateral semitendinosus tendon graft. The semitendinosus tendon is harvested through an incision in the medial aspect of the popliteal fossa, and the proximal stump is exposed and mobilized through an incision performed 2 cm proximal and medial to the palpable tendon gap. We repeat the same steps distally, approaching the distal stump of the tendon through a 2.5 cm longitudinal incision made 2 cm distal and just anterior to the lateral margin of the distal stump. Through the distal incision, we expose the Kager's space and the postero-superior corner of the osteotomized calcaneum. We drill a bone tunnel into the calcaneum from dorsal to plantar using a cannulated headed reamer. The semitendinosus tendon graft is passed into the proximal stump through a medial-to-lateral small incision, its two ends are moved distally, and finally it is pulled down and shuttled through the bone tunnel. The construct is fixed to the calcaneum using an interference screw. Immobilization in a below the knee plaster cast with the foot in plantar flexion for 2 weeks, weight bearing on the metatarsal heads as tolerated, use elbow crutches, and keep the knee flexed. At 2 weeks, plaster removed, and rehabilitative exercises started, walker cast allowed. Between 2008 and 2010, the procedure was performed on 28 consecutive patients (21 men and 7 women, median age 46 years). At the 2-year follow-up, average ATRS scores significantly improved (p < 0.0001) compared to average preoperative

Comparison of knee flexion isokinetic deficits between seated and prone positions after ACL reconstruction with hamstrings graft: Implications for rehabilitation and return to sports decisions.

PubMed

Koutras, Georgios; Bernard, Manfred; Terzidis, Ioannis P; Papadopoulos, Pericles; Georgoulis, Anastasios; Pappas, Evangelos

2016-07-01

Hamstrings grafts are commonly used in ACL reconstruction, however, the effect of graft harvesting on knee flexion strength has not been longitudinally evaluated in functional positions. We hypothesized that greater deficits in knee flexion strength exist in the prone compared to the seated position and these deficits remain as rehabilitation progresses. Case series. Forty-two consecutive patients who underwent ACL reconstruction with a hamstrings graft were followed prospectively for 9 months. Isokinetic knee flexion strength at a slow and a fast speed were collected at 3, 4, 6, and 9 months in two different positions: conventional (seated) and functional (0° of hip flexion). Peak torque knee flexion deficits were higher in the prone position compared to the seated position by an average of 6.5% at 60°/s and 9.1% at 180°/s (p<0.001). Measuring knee flexion strength in prone demonstrates higher deficits than in the conventional seated position. Most athletes would not be cleared to return to sports even at 9 months after surgery with this method. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Treatment of mallet finger deformity with a modified palmaris longus tendon graft through a bone tunnel.

PubMed

Liu, Zengbing; Ma, Kai; Huang, Dong

2018-01-01

To investigate the clinical effect of treating mallet finger deformity using a modified palmaris longus tendon graft through a bone tunnel. Altogether, 21 patients with mallet finger deformity (16 men, 5 women; average age 31 years, range 19-47 years) were treated with a modified palmaris longus tendon graft through a bone tunnel during 18 months (2014-2016). Four index fingers, seven middle fingers, eight ring fingers, and two little fingers were treated for four cutting injuries, eleven finger sprains, four crush injuries, and two twist injuries (7 open and 14 closed injuries). Duration from injury to surgery was 9 h to 13 weeks. Three patients underwent surgery after 6 weeks of unsuccessful conservative treatment. No tendon was attached to the extensor tendon insertion in 16 patients, and 5 had residual tendon of <0.2 cm attached. All patients had distal segment flexion deformity and dorsiflexion disorder. Surgery comprised transverse penetration and vertical drilling of the base of the distal phalanx (2.0 and 2.5 mm diameter drills). Equal shallow semitendinosus pieces of the palmaris longus tendon (4 cm) were obtained from the sagittal end and were passed through a dorsal bone hole, emerging from a transverse bone hole. The two bundles were sutured to the main tendon. Tension was adjusted, and the broken ends were sutured. The distal interphalangeal joints were fixed in hyperextension. All patients were followed for 7-16 months (average 6.0 ± 0.3 months) postoperatively. All 21 patients had grade A wound healing, with no complications (e.g., necrotic wound, recurrence, joint stiffness). The mallet finger deformity was corrected with good appearance, no obvious abnormalities, and satisfactory flexion and extension. Two patients had a superficial wound infection. Each recovered after symptomatic treatment. One patient had a mild result, with limited extension. There were no recurrences. Results were evaluated according to Patel et al.'s system, which revealed

Hamstring autograft size importance in anterior cruciate ligament repair surgery

PubMed Central

Figueroa, Francisco; Figueroa, David; Espregueira-Mendes, João

2018-01-01

Graft size in hamstring autograft anterior cruciate ligament (ACL) surgery is an important factor directly related to failure. Most of the evidence in the field suggests that the size of the graft in hamstring autograft ACL reconstruction matters when the surgeon is trying to avoid failures. The exact graft diameter needed to avoid failures is not absolutely clear and could depend on other factors, but newer studies suggest than even increases of 0.5 mm up to a graft size of 10 mm are beneficial for the patient. There is still no evidence to recommend the use of grafts > 10 mm. Several methods – e.g. folding the graft in more strands – that are simple and reproducible have been published lately to address the problem of having an insufficient graft size when performing an ACL reconstruction. Due to the evidence presented, we think it is necessary for the surgeon to have them in his or her arsenal before performing an ACL reconstruction. There are obviously other factors that should be considered, especially age. Therefore, a larger graft size should not be taken as the only goal in ACL reconstruction. Cite this article: EFORT Open Rev 2018;3:93-97. DOI: 10.1302/2058-5241.3.170038 PMID:29657850

Hamstring autograft size importance in anterior cruciate ligament repair surgery.

PubMed

Figueroa, Francisco; Figueroa, David; Espregueira-Mendes, João

2018-03-01

Graft size in hamstring autograft anterior cruciate ligament (ACL) surgery is an important factor directly related to failure. Most of the evidence in the field suggests that the size of the graft in hamstring autograft ACL reconstruction matters when the surgeon is trying to avoid failures.The exact graft diameter needed to avoid failures is not absolutely clear and could depend on other factors, but newer studies suggest than even increases of 0.5 mm up to a graft size of 10 mm are beneficial for the patient. There is still no evidence to recommend the use of grafts > 10 mm.Several methods - e.g. folding the graft in more strands - that are simple and reproducible have been published lately to address the problem of having an insufficient graft size when performing an ACL reconstruction. Due to the evidence presented, we think it is necessary for the surgeon to have them in his or her arsenal before performing an ACL reconstruction.There are obviously other factors that should be considered, especially age. Therefore, a larger graft size should not be taken as the only goal in ACL reconstruction. Cite this article: EFORT Open Rev 2018;3:93-97. DOI: 10.1302/2058-5241.3.170038.

Tendon-bone graft for tendinous mallet fingers following failed splinting.

PubMed

Wang, Le; Zhang, Xu; Liu, Ze; Huang, Xiuge; Zhu, Hongwei; Yu, Yadong

2013-12-01

To describe and assess a surgical technique for the treatment of tendinous mallet fingers after failed conservative treatment. From January 2010 to March 2012, 28 tendinous mallet fingers in 28 patients were treated. All patients had greater than 25° extensor lags after 6 to 8 weeks of splinting. Four patients had a second trial of splinting, which also failed. A tendon-bone graft, taken from the extensor carpi radialis brevis and the third metacarpal base, was used for reconstruction. The mean time between the injury and operation was 74 days. The mean preoperative extension lag was 34°. Five patients reported pain in the distal interphalangeal joint. At the final follow-up, patients rated the level of pain on the distal interphalangeal and wrist joints using a visual analog scale. Joint motion was graded with the Crawford criteria. Hand function was assessed with the Disabilities of the Arm, Shoulder, and Hand questionnaire. Patients reported on their satisfaction based on the Michigan Hand Outcomes Questionnaire. Bone healing was achieved in all patients at a mean of 5 weeks. Position of bone graft was maintained until bone healing was evident in all cases. At the mean follow-up period of 15 months, nail deformity was not noted. No patient reported pain on the distal interphalangeal joint or wrist. The mean residual extension lag of the distal interphalangeal joints was 4°. The results showed that 24 digits were excellent and 4 were good based on the Crawford criteria. The Disabilities of the Arm, Shoulder, and Hand scores averaged 1, and 27 patients were satisfied with appearance of the hand. One patient sometimes felt uncomfortable regarding the appearance. A tendon-bone graft is a useful and reliable technique for the treatment of tendinous mallet fingers after failed splinting. Therapeutic IV. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Hamstring Strength and Morphology Progression after Return to Sport from Injury

PubMed Central

Sanfilippo, Jennifer; Silder, Amy; Sherry, Marc A; Tuite, Michael J; Heiderscheit, Bryan C

2012-01-01

Hamstring strain re-injury rates can reach 30% within the initial two weeks following return to sport (RTS). Incomplete recovery of strength may be a contributing factor. However, relative strength of the injured and unaffected limbs at RTS is currently unknown. PURPOSE: Characterize hamstring strength and morphology at the time of RTS and six months later. METHODS: Twenty-five athletes that experienced an acute hamstring strain injury participated, following completion of a controlled rehabilitation program. Bilateral isokinetic strength testing and magnetic resonance imaging (MRI) were performed at RTS and 6-months later. Strength (knee flexion peak torque, work, angle of peak torque) and MRI (muscle and tendon volumes) measures were compared between limbs and over time using repeated measures ANOVA. RESULTS: The injured limb showed a peak torque deficit of 9.6% compared to the uninjured limb at RTS (60°/s, p<0.001), but not 6-months following. The knee flexion angle of peak torque decreased over time for both limbs (60°/s, p<0.001). MRI revealed that 20.4% of the muscle cross-sectional area showed signs of edema at RTS with full resolution by the 6-month follow-up. Tendon volume of the injured limb tended to increase over time (p=0.108), while muscle volume decreased 4–5% in both limbs (p<0.001). CONCLUSION: Residual edema and deficits in isokinetic knee flexion strength were present at RTS, but resolved during the subsequent six months. This occurred despite MRI evidence of scar tissue formation (increased tendon volume) and muscle atrophy, suggesting that neuromuscular factors may contribute to the return of strength. PMID:23059864

Muscle and intensity based hamstring exercise classification in elite female track and field athletes: implications for exercise selection during rehabilitation

PubMed Central

Tsaklis, Panagiotis; Malliaropoulos, Nikos; Mendiguchia, Jurdan; Korakakis, Vasileios; Tsapralis, Kyriakos; Pyne, Debasish; Malliaras, Peter

2015-01-01

Background Hamstring injuries are common in many sports, including track and field. Strains occur in different parts of the hamstring muscle but very little is known about whether common hamstring loading exercises specifically load different hamstring components. The purpose of this study was to investigate muscle activation of different components of the hamstring muscle during common hamstring loading exercises. Methods Twenty elite female track and field athletes were recruited into this study, which had a single-sample, repeated-measures design. Each athlete performed ten hamstring loading exercises, and an electromyogram (EMG) was recorded from the biceps femoris and semitendinosus components of the hamstring. Hamstring EMG during maximal voluntary isometric contraction (MVIC) was used to normalize the mean data across ten repetitions of each exercise. An electrogoniometer synchronized to the EMG was used to determine whether peak EMG activity occurred during muscle-tendon unit lengthening, shortening, or no change in length. Mean EMG values were compared between the two recording sites for each exercise using the Student’s t-test. Results The lunge, dead lift, and kettle swings were low intensity (<50% MVIC) and all showed higher EMG activity for semitendinosus than for biceps femoris. Bridge was low but approaching medium intensity, and the TRX, hamstring bridge, and hamstring curl were all medium intensity exercises (≥50% or <80% MVIC). The Nordic, fitball, and slide leg exercises were all high intensity exercises. Only the fitball exercise showed higher EMG activity in the biceps femoris compared with the semitendinosus. Only lunge and kettle swings showed peak EMG in the muscle-tendon unit lengthening phase and both these exercises involved faster speed. Conclusion Some exercises selectively activated the lateral and medial distal hamstrings. Low, medium, and high intensity exercises were demonstrated. This information enables the clinician, strength

Muscle and intensity based hamstring exercise classification in elite female track and field athletes: implications for exercise selection during rehabilitation.

PubMed

Tsaklis, Panagiotis; Malliaropoulos, Nikos; Mendiguchia, Jurdan; Korakakis, Vasileios; Tsapralis, Kyriakos; Pyne, Debasish; Malliaras, Peter

2015-01-01

Hamstring injuries are common in many sports, including track and field. Strains occur in different parts of the hamstring muscle but very little is known about whether common hamstring loading exercises specifically load different hamstring components. The purpose of this study was to investigate muscle activation of different components of the hamstring muscle during common hamstring loading exercises. Twenty elite female track and field athletes were recruited into this study, which had a single-sample, repeated-measures design. Each athlete performed ten hamstring loading exercises, and an electromyogram (EMG) was recorded from the biceps femoris and semitendinosus components of the hamstring. Hamstring EMG during maximal voluntary isometric contraction (MVIC) was used to normalize the mean data across ten repetitions of each exercise. An electrogoniometer synchronized to the EMG was used to determine whether peak EMG activity occurred during muscle-tendon unit lengthening, shortening, or no change in length. Mean EMG values were compared between the two recording sites for each exercise using the Student's t-test. The lunge, dead lift, and kettle swings were low intensity (<50% MVIC) and all showed higher EMG activity for semitendinosus than for biceps femoris. Bridge was low but approaching medium intensity, and the TRX, hamstring bridge, and hamstring curl were all medium intensity exercises (≥50% or <80% MVIC). The Nordic, fitball, and slide leg exercises were all high intensity exercises. Only the fitball exercise showed higher EMG activity in the biceps femoris compared with the semitendinosus. Only lunge and kettle swings showed peak EMG in the muscle-tendon unit lengthening phase and both these exercises involved faster speed. Some exercises selectively activated the lateral and medial distal hamstrings. Low, medium, and high intensity exercises were demonstrated. This information enables the clinician, strength and conditioning coach and

[EFFECTIVENESS COMPARISON OF CORACOCLAVICULAR LIGAMENT RECONSTRUCTION BETWEEN BY AUTOLOGOUS AND ALLOGENEIC TENDON GRAFTS COMBINED WITH HOOK PLATE FIXATION FOR TREATING ACROMIOCLAVICULAR JOINT DISLOCATION].

PubMed

Yin, Fei; Sun, Zhenzhong; Wei, Xuming; Liu, Xueguang; Zhou, Ming; Zhuang, Yin; Song, Sheng

2016-05-08

To compare the effectiveness of coracoclavicular ligament reconstruction between by using autologous plantaris tendon graft combined with hook plate fixation and allogeneic tendon graft combined with hook plate fixation for treating acromiocavicular joint dislocation. Thirty-three patients with acromioclavicular joint dislocation who accorded with the inclusion criteria between January 2013 and June 2014 were assigned into 2 groups. The patients were treated with autologous plantaris tendon graft combined with hook plate fixation in group A ( n =17), and with allogeneic tendon graft combined with hook plate fixation in group B ( n =16). Thirteen-one patients was followed up more than 12 months (15 in group A and 16 in group B). There was no significant difference in gender, age, cause of injury, sides, time between injury and surgery, and type of dislocation ( P >0.05). The assessments included operation time, hospitalization time, hospitalization expenses, shoulder range of motion, gap of acromioclavicular, Constant-Murley scores, and visual analogue scale (VAS) for pain. The operation time of group A was significantly longer than that of group B, and the hospitalization expense was significantly lower than that of group B ( P <0.05). There was no significant difference in hospitalization time ( t =1.046, P =0.316). The incisions healed by first intention, and hook plate was removed after 3 months. The mean follow-up time was 21.3 months (range, 19-34 months) in group A and was 23.7 months (range, 18-37 months) in group B. X-ray examination showed no osteolysis. There was no significant difference in gap of acromiocavicular between 2 groups at preoperation, 1 week after operation, and last follow-up ( P >0.05). No redislocation of acromioclavicular joint and rejection reaction occurred during follow-up. At last follow-up, there was no significant difference in shoulder range of motion, Constant-Murley score, and VAS score between 2 groups ( P >0

Step Cut Lengthening: A Technique for Treatment of Flexor Pollicis Longus Tendon Rupture.

PubMed

Chong, Chew-Wei; Chen, Shih-Heng

2018-04-01

Reconstruction of a tendon defect is a challenging task in hand surgery. Delayed repair of a ruptured flexor pollicis longus (FPL) tendon is often associated with tendon defect. Primary repair of the tendon is often not possible, particularly after debridement of the unhealthy segment of the tendon. As such, various surgical treatments have been described in the literature, including single-stage tendon grafting, 2-stage tendon grafting, flexor digitorum superficialis tendon transfer from ring finger, and interphalangeal joint arthrodesis. We describe step cut lengthening of FPL tendon for the reconstruction of FPL rupture. This is a single-stage reconstruction without the need for tendon grafting or tendon transfer. To our knowledge, no such technique has been previously described.

Isokinetic evaluation of internal/external tibial rotation strength after the use of hamstring tendons for anterior cruciate ligament reconstruction.

PubMed

Armour, Tanya; Forwell, Lorie; Litchfield, Robert; Kirkley, Alexandra; Amendola, Ned; Fowler, Peter J

2004-01-01

Evaluation of the knee after an anterior cruciate ligament reconstruction with the use of the semitendinosus and gracilis (hamstring) autografts has primarily focused on flexion and extension strength. The semitendinosus and gracilis muscles contribute to internal tibial rotation, and it has been suggested that harvest of these tendons for the purpose of an anterior cruciate ligament reconstruction contributes to internal tibial rotation weakness. Internal tibial rotation strength may be affected by the semitendinosus and gracilis harvest after anterior cruciate ligament reconstruction. Prospective evaluation of internal and external tibial rotation strength. Inclusion criteria for subjects (N = 30): unilateral anterior cruciate ligament reconstruction at least 2 years previously, a stable anterior cruciate ligament (<5-mm side-to-side difference) at time of testing confirmed by surgeon and KT-1000 arthrometer, no history of knee problems after initial knee reconstruction, a normal contralateral knee, and the ability to comply with the testing protocol. In an attempt to minimize unwanted subtalar joint motion, subjects were immobilized using an ankle brace and tested at angular velocities of 60 degrees /s, 120 degrees /s, and 180 degrees /s at a knee flexion angle of 90 degrees . The mean peak torque measurements for internal rotation strength of the operative limb (60 degrees /s, 17.4 +/- 4.5 ft-lb; 120 degrees /s, 13.9 +/- 3.3 ft-lb; 180 degrees /s, 11.6 +/- 3.0 ft-lb) were statistically different compared to the nonoperated limb (60 degrees /s, 20.5 +/- 4.7 ft-lb; 120 degrees /s, 15.9 +/- 3.8 ft-lb; 180 degrees /s, 13.4 +/- 3.8 ft-lb) at 60 degrees /s (P = .012), 120 degrees /s (P = .036), and 180 degrees /s (P = .045). The nonoperative limb demonstrated greater strength at all speeds. The mean torque measurements for external rotation were statistically similar when compared to the nonoperated limb at all angular velocities. We have shown through our study that

Anatomical study of the proximal origin of hamstring muscles.

PubMed

Sato, Kengo; Nimura, Akimoto; Yamaguchi, Kumiko; Akita, Keiichi

2012-09-01

It is relatively well accepted that the long head of the biceps femoris and the semitendinosus both originate from the ischial tuberosity as a common tendon. However, it is also widely known that the biceps femoris is consistently injured more than the semitendinosus. The purpose of this study was to examine the origins of the hamstring muscles, to find an anatomic basis for diagnosis and treatment of injuries of the posterior thigh regions. Twenty-eight hips of fourteen adult Japanese cadavers were used in this study. In twenty hips of ten cadavers, the positional relationships among the origins on the ischial tuberosity were examined. In eight hips of four cadavers, histological examination of the origins of the hamstrings was also performed. The origin of the long head of the biceps femoris adjoined that of the semitendinosus. In the proximal regions of these muscles, the long head consisted of the tendinous part; however, the semitendinosus mainly consisted of the muscular part. Some of the fibers of the biceps tendon extended to fuse with the sacrotuberous ligament. The semimembranosus muscle broadly originated from the lateral surface of the ischial tuberosity. The origins of the long head of the biceps femoris and the semitendinosus are found to be almost independent, and the tendon of the long head is partly fused with the sacrotuberous ligament. The high incidence of injuries to the long head of the biceps femoris could be explained by these anatomical configurations.

Effect of tendon tensioning: an in vitro study in porcine extensor tendons.

PubMed

Figueroa, David; Calvo, Rafael; Vaisman, Alex; Meleán, Patricio; Figueroa, Francisco

2010-06-01

Graft tensioning is a controversial issue in anterior cruciate ligament reconstruction (ACLR) that has not achieved consensus between peers. The purpose of this study is to determine if after tensioning tendon length and resistance to maximal load changes. We performed an in vitro study with 50 porcine extensors tendons. The first group (P=25) was tensioned with 80 N (19.97 lb) for 10 min, using an ACL graft preparation board. The second group (C=25) was used as control and was not tensioned. The average initial (groups P and C) and post tensioning tendon length (group C) were measured; the average initial and post tensioning tendon diameter were measured as well. All samples were fixated in a tube-clamp system connected to a tension sensor. The samples were stressed with continuous and progressive tension until ultimate failure at maximum load (UFML) occurs. The initial mean length was: P before tensioning=13.4 mm+/-1.4 mm (range 10.5-16.5); P after tensioning=13.8 mm+/-1.4 mm (range 11.5-16.5); C=13 mm+/-1.35 mm (p=0.005). The mean diameter was: P=5.6 mm (4.5-6); C=5.5 mm (range 4.5-6) (p>0.05). The UFML was: P=189.7 N (114-336); C=229.9 N (143-365) (p=0.029). Tendon tensioning with 80 N for 10 min produced 3% average elongation. These could be beneficial in ACLR since tendon tensioning decreases elongation of the graft after fixation. Regardless, tendon tensioning is not innocuous since it diminishes their resistance when continuously stressed until complete failure occurs.

A comparison of revision and rerupture rates of ACL reconstruction between autografts and allografts in the skeletally immature.

PubMed

Nelson, Ian R; Chen, Jason; Love, Rebecca; Davis, Brent R; Maletis, Gregory B; Funahashi, Tadashi T

2016-03-01

Anterior cruciate ligament reconstructions (ACLRs) in skeletally immature patients are increasing. The purpose of this study is to describe the demographics, graft usage, revision, and re-operation rates in skeletally immature ACLRs in the Kaiser Permanente healthcare system. Skeletally immature patients (<17.0 years old with open physes) were identified using the Kaiser Permanente ACLR registry. Multi-ligament reconstructions and physeal-sparing ACLRs were excluded. Aseptic revision and same-knee re-operation were the outcomes of interest. Exposure of interest was graft type; bone-patellar-tendon-bone (BPTB) autograft, hamstring autograft, and any type of allograft. Age, gender, body mass index (BMI), and race were evaluated as confounders. Cox proportional hazard models stratified by surgeon were used to analyse the risk of revision and re-operation. A total of 534 primary ACLR cases were evaluated with a mean follow-up of 2.9 years. The majority were hamstring autografts (n = 388, 72.7%), male (n = 339, 63.9%), and White (n = 232, 43.4%). Median age was 14.9 years, and median BMI was 21.9 kg/m(2). There were 44 (8.2%) aseptic revisions and 48 (9.0%) same-knee re-operations. The incidence rate for revision was BPTB autograft 5.5%, hamstring autograft 7.5%, and allograft 13.2%. After adjusting for confounders and surgeon clustering effect, the risk of aseptic revision and revision between allograft and hamstring autograft did not reach statistical significance. Graft selection differs in skeletally immature patients with a preponderance of surgeries being performed with hamstring tendon autografts. High revision rates were identified for all graft types used, though differences in revision rates across different graft types did not reach statistical significance. Surgeons should be aware of high rates of revision in this skeletally immature young population, although type of graft used did not appear to make a difference. III.

Tendon 'turnover lengthening' technique.

PubMed

Cerovac, S; Miranda, B H

2013-11-01

Tendon defect reconstruction is amongst the most technically challenging areas in hand surgery. Tendon substance deficiency reconstruction techniques include lengthening, grafting, two-stage reconstruction and tendon transfers, however each is associated with unique challenges over and above direct repair. We describe a novel 'turnover lengthening' technique for hand tendons that has successfully been applied to the repair of several cases, including a case of attritional flexor and traumatic extensor tendon rupture in two presented patients where primary tenorrhaphy was not possible. In both cases a good post-operative outcome was achieved, as the patients were happy having returned back to normal activities of daily living such that they were discharged 12 weeks post-operatively. Our technique avoids the additional morbidity and complications associated with grafting, transfers and two stage reconstructions. It is quick, simple and reproducible for defects not exceeding 3-4 cm, provides a means of immediate one stage reconstruction, no secondary donor site morbidity and does not compromise salvage by tendon transfer and/or two-stage reconstruction in cases of failure. To our knowledge no such technique has been previously been described to reconstruct such hand tendon defects. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Biodegradable screw versus a press-fit bone plug fixation for hamstring anterior cruciate ligament reconstruction: a prospective randomized study.

PubMed

Jagodzinski, Michael; Geiges, Bjoern; von Falck, Christian; Knobloch, Karsten; Haasper, Carl; Brand, Juergen; Hankemeier, Stefan; Krettek, Christian; Meller, Rupert

2010-03-01

Press-fit fixation of a tendon graft has been advocated to achieve tendon-to-bone healing. Fixation of hamstring tendon grafts with a porous bone scaffold limits bone tunnel enlargement compared with a biodegradable interference screw fixation. Randomized controlled trial; Level of evidence, 1. Methods Between 2005 and 2006, 20 patients (17 men, 3 women) with a primary reconstruction of the anterior cruciate ligament (ACL) were enrolled in this study. Patients were randomized to obtain graft fixation in the tibial tunnel either by means of an interference screw (I) or a press-fit fixation with a porous bone cylinder (P). At 3 months after surgery, a computed tomography (CT) scan of the knee was performed, and tunnel enlargement was analyzed in the coronal and sagittal planes for the proximal, middle, and distal thirds of the tunnel. After 6 months and 1 and 2 years, radiographs of the knee in the sagittal and coronal plane were analyzed for bone tunnel widening. The International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores of both groups were compared after 1 and 2 years. The bone tunnel enlargement determined by CT was 106.9% + or - 10.9% for group P and 121.9% + or - 9.0% for group I (P < .02) in the anteroposterior (AP) plane and 102.8% + or - 15.2% versus 121.5% + or - 10.1% in the coronal plane (P <.01). The IKDC, Tegner, and Lysholm scores improved in both groups from preoperatively to postoperatively without significant differences between the 2 groups. There was a trend to higher knee stability in group P after 3 months (0.6 + or - 1.4 mm vs 1.8 + or - 1.5 mm; P = .08). Both interference screw and a press-fit fixation lead to a high number of good or very good outcomes after ACL reconstruction. Tibial press-fit fixation decreases the amount of proximal bone tunnel enlargement.

Quadriceps Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Systematic Review.

PubMed

Hurley, Eoghan T; Calvo-Gurry, Manuel; Withers, Dan; Farrington, Shane K; Moran, Ray; Moran, Cathal J

2018-05-01

To systematically review the current evidence to ascertain whether quadriceps tendon autograft (QT) is a viable option in anterior cruciate ligament reconstruction. A literature review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Cohort studies comparing QT with bone-patellar tendon-bone autograft (BPTB) or hamstring tendon autograft (HT) were included. Clinical outcomes were compared, with all statistical analyses performed using IBM SPSS Statistics for Windows, version 22.0, with P < .05 being considered statistically significant. We identified 15 clinical trials with 1,910 patients. In all included studies, QT resulted in lower rates of anterior knee pain than BPTB. There was no difference in the rate of graft rupture between QT and BPTB or HT in any of the studies reporting this. One study found that QT resulted in greater knee stability than BPTB, and another study found increased stability compared with HT. One study found that QT resulted in improved functional outcomes compared with BPTB, and another found improved outcomes compared with HT, but one study found worse outcomes compared with BPTB. Current literature suggests QT is a viable option in anterior cruciate ligament reconstruction, with published literature showing comparable knee stability, functional outcomes, donor-site morbidity, and rerupture rates compared with BPTB and HT. Level III, systematic review of Level I, II, and III studies. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Self-Mobilization Using a Foam Roller Versus a Roller Massager: Which Is More Effective for Increasing Hamstrings Flexibility?

PubMed

DeBruyne, Danielle M; Dewhurst, Marina M; Fischer, Katelyn M; Wojtanowski, Michael S; Durall, Chris

2017-01-01

Clinical Scenario: Increasing the length of the muscle-tendon unit may prevent musculotendinous injury. Various methods have been proposed to increase muscle-tendon flexibility, including self-mobilization using foam rollers or roller massagers, although the effectiveness of these devices is uncertain. This review was conducted to determine if the use of foam rollers or roller massagers to improve hamstrings flexibility is supported by moderate- to high-quality evidence. Are foam rollers or roller massagers effective for increasing hamstrings flexibility in asymptomatic physically active adults? Summary of Key Findings: The literature was searched for studies on the effects of using foam rollers or roller massagers to increase hamstrings flexibility in asymptomatic physically active adults. Four randomized controlled trials were included; 2 studies provided level 2 or 3 evidence regarding foam rollers and 2 studies provided level 2 or 3 evidence regarding roller massagers. Both roller-massager studies reported increases in hamstrings flexibility after treatment. Data from the foam-roller studies did not demonstrate a statistically significant increase in hamstrings flexibility, but 1 study did demonstrate a strong effect size. Clinical Bottom Line: The reviewed moderate-quality studies support the use of roller massagers but provide limited evidence on the effectiveness of foam rolling to increase hamstrings flexibility in asymptomatic physically active adults. Flexibility gains may be improved by a longer duration of treatment and administration by a trained therapist. Gains appear to decline rapidly postrolling. Neither device has been shown to confer a therapeutic benefit superior to static stretching, and the effectiveness of these devices for preventing injury is unknown. Strength of Recommendation: Grade B evidence supports the use of roller massagers to increase hamstrings flexibility in asymptomatic physically active adults.

Pitfalls during biomechanical testing - Evaluation of different fixation methods for measuring tendons endurance properties.

PubMed

Hangody, Gy; Pánics, G; Szebényi, G; Kiss, R; Hangody, L; Pap, K

2016-03-01

The goal of the study was to find a proper technique to fix tendon grafts into an INSTRON loading machine. From 8 human cadavers, 40 grafts were collected. We removed the bone-patella tendon-bone grafts, the semitendinosus and gracilis tendons, the quadriceps tendon-bone grafts, the Achilles tendons, and the peroneus longus tendons from each lower extremity. We tested the tendon grafts with five different types of fixation devices: surgical thread (Premicron 3), general mounting clamp, wire mesh, cement fixation, and a modified clamp for an INSTRON loading machine. The mean failure load in case of surgical thread fixation was (381N ± 26N). The results with the general clamp were (527N ± 45N). The wire meshes were more promising (750N ± 21N), but did not reach the outcomes we desired. Easy slippages of the ends of the tendons from the cement encasements were observed (253N ± 18N). We then began to use Shi's clamp that could produce 977N ± 416N peak force. We combined Shi's clamp with freezing of the graft and the rupture of the tendon itself demonstrated an average force of 2198 N ± 773N. We determined that our modified frozen clamp fixed the specimens against high tensile forces.

Tunnel widening prevention with the allo-Achilles tendon graft in anterior cruciate ligament reconstruction: Surgical tips and short term followup

PubMed Central

Suh, Dong Won; Han, Seung Beom; Yeo, Woo Jin; Lee, Won Hee; Kwon, Jae Ho; Kyung, Bong Soo

2017-01-01

Background: Tunnel widening (TW) after anterior cruciate ligament (ACL) reconstruction can be a serious complication, and there is controversy over how to prevent it. This study aimed to suggest surgical approaches to prevent TW using an allo-Achilles tendon graft, and then to evaluate TW after these surgical tips were applied. Materials and Methods: Sixty two patients underwent ACL reconstruction with an allo-Achilles tendon graft. Four surgical approaches were used: Making a tibial tunnel by bone impaction, intraarticular reamer application, bone portion application for the femoral tunnel, and an additional bone plug application for the tibial tunnel. After more than 1-year, followup radiographs including anteroposterior and lateral views were taken in 29 patients encompassing thirty knees. The diameter of the tunnels at postoperation day 1 (POD1) and at followup was measured and compared. Results: In 18 knees (60%), there were no visible femoral tunnel margins on the radiographs at POD1 or followup. In the other 12 cases, which had visible femoral tunnel margins on followup radiographs, the mean femoral tunnel diameter was 8.6 mm. In the tibial tunnel, the mean diameters did not increase on all three levels (proximal, middle, and distal), and there was no statistically significant difference between the diameters at POD1 and followup. Conclusion: The suggested tips for surgery involving an allo-Achilles tendon graft can effectively prevent TW after ACL reconstruction according to this case series. These surgical tips can prevent TW. PMID:28400663

Determinants of Return to Play After the Nonoperative Management of Hamstring Injuries in Athletes: A Systematic Review.

PubMed

Fournier-Farley, Camille; Lamontagne, Martin; Gendron, Patrick; Gagnon, Dany H

2016-08-01

It is important for clinicians to rely on suitable prognosis factors after hamstring injuries because of the high incidence of these injuries and time away from athletic activities. To summarize the current literature on factors that influence return to play after a hamstring injury in athletes. Systematic review. A computer-assisted literature search of CINAHL, MEDLINE, Embase, and EBM Reviews databases (and a manual search of the reference lists of all selected articles) was conducted using keywords related to hamstring injuries and return to play. The literature review criteria included (1) patients with an acute hamstring or posterior thigh injury; (2) a randomized controlled trial, cohort study, case-control study, case series, or prospective or retrospective design; (3) information on rehabilitation, physical therapy, clinical assessment, imaging techniques, and return to play; and (4) studies written in English or French. The search strategy identified 914 potential articles, of which 24 met the inclusion criteria. In terms of the clinical assessment, the following factors were associated with a longer recovery time: stretching-type injuries, recreational-level sports, structural versus functional injuries, greater range of motion deficit with the hip flexed at 90°, time to first consultation >1 week, increased pain on the visual analog scale, and >1 day to be able to walk pain free after the injury. As for magnetic resonance imaging studies, the following factors correlated with a longer recovery time: positive findings; higher grade of injury; muscle involvement >75%; complete transection; retraction; central tendon disruption of the biceps femoris; proximal tendon involvement; shorter distance to the ischial tuberosity; length of the hamstring injury; and depth, volume, and large cross-sectional area. With respect to ultrasound studies, the following factors were associated with a poor prognosis: large cross-sectional area, injury outside the

Mechanoactive Scaffold Induces Tendon Remodeling and Expression of Fibrocartilage Markers

PubMed Central

Spalazzi, Jeffrey P.; Vyner, Moira C.; Jacobs, Matthew T.; Moffat, Kristen L.

2008-01-01

Biological fixation of soft tissue-based grafts for anterior cruciate ligament (ACL) reconstruction poses a major clinical challenge. The ACL integrates with subchondral bone through a fibrocartilage enthesis, which serves to minimize stress concentrations and enables load transfer between two distinct tissue types. Functional integration thus requires the reestablishment of this fibrocartilage interface on reconstructed ACL grafts. We designed and characterized a novel mechanoactive scaffold based on a composite of poly-α-hydroxyester nanofibers and sintered microspheres; we then used the scaffold to test the hypothesis that scaffold-induced compression of tendon grafts would result in matrix remodeling and the expression of fibrocartilage interface-related markers. Histology coupled with confocal microscopy and biochemical assays were used to evaluate the effects of scaffold-induced compression on tendon matrix collagen distribution, cellularity, proteoglycan content, and gene expression over a 2-week period. Scaffold contraction resulted in over 15% compression of the patellar tendon graft and upregulated the expression of fibrocartilage-related markers such as Type II collagen, aggrecan, and transforming growth factor-β3 (TGF-β3). Additionally, proteoglycan content was higher in the compressed tendon group after 1 day. The data suggest the potential of a mechanoactive scaffold to promote the formation of an anatomic fibrocartilage enthesis on tendon-based ACL reconstruction grafts. PMID:18512112

Mechanoactive scaffold induces tendon remodeling and expression of fibrocartilage markers.

PubMed

Spalazzi, Jeffrey P; Vyner, Moira C; Jacobs, Matthew T; Moffat, Kristen L; Lu, Helen H

2008-08-01

Biological fixation of soft tissue-based grafts for anterior cruciate ligament (ACL) reconstruction poses a major clinical challenge. The ACL integrates with subchondral bone through a fibrocartilage enthesis, which serves to minimize stress concentrations and enables load transfer between two distinct tissue types. Functional integration thus requires the reestablishment of this fibrocartilage interface on reconstructed ACL grafts. We designed and characterized a novel mechanoactive scaffold based on a composite of poly-alpha-hydroxyester nanofibers and sintered microspheres; we then used the scaffold to test the hypothesis that scaffold-induced compression of tendon grafts would result in matrix remodeling and the expression of fibrocartilage interface-related markers. Histology coupled with confocal microscopy and biochemical assays were used to evaluate the effects of scaffold-induced compression on tendon matrix collagen distribution, cellularity, proteoglycan content, and gene expression over a 2-week period. Scaffold contraction resulted in over 15% compression of the patellar tendon graft and upregulated the expression of fibrocartilage-related markers such as Type II collagen, aggrecan, and transforming growth factor-beta3 (TGF-beta3). Additionally, proteoglycan content was higher in the compressed tendon group after 1 day. The data suggest the potential of a mechanoactive scaffold to promote the formation of an anatomic fibrocartilage enthesis on tendon-based ACL reconstruction grafts.

The Effects of Bio-Lubricating Molecules on Flexor Tendon Reconstruction in A Canine Allograft Model In Vivo

PubMed Central

Zhao, Chunfeng; Wei, Zhuang; Kirk, Ramona L.; Thoreson, Andrew R.; Jay, Gregory D.; Moran, Steven L.; An, Kai-Nan; Amadio, Peter C.

2014-01-01

Background Using allograft is an attractive alternative for flexor tendon reconstruction because of the lack of donor morbidity, and better matching to the intrasynovial environment. The purpose of this study was to use biolubricant molecules to modify the graft surface to decrease adhesions and improve digit function. Methods 28 flexor digitorum profundus (FDP) tendons from the 2nd and 5th digits of 14 dogs were first lacerated and repaired to create a model with repair failure and scar digit for tendon reconstruction. Six weeks after the initial surgery, the tendons were reconstructed with FDP allograft tendons obtained from canine cadavers. One graft tendon in each dog was treated with saline as a control and the other was treated with gelatin, carbodiimide derivatized, hyaluronic acid and lubricin (cd-HA-Lubricin). Six weeks postoperatively, digit function, graft mechanics, and biology were analyzed. Results Allograft tendons treated with cd-HA-Lubricin had decreased adhesions at the proximal tendon/graft repair and within flexor sheath, improved digit function, and increased graft gliding ability. The treatment also reduced the strength at the distal tendon to bone repair, but the distal attachment rupture rate was similar for both graft types. Histology showed that viable cells migrated to the allograft, but these were limited to the tendon surface. Conclusion cd-HA-Lubricin treatment of tendon allograft improves digit functional outcomes after flexor tendon reconstruction. However, delayed bone-tendon healing should be a caution. Furthermore, the cell infiltration into the allograft tendons substance should be a target for future studies, to shorten the allograft self-regeneration period. PMID:24445876

Hamstring Injury

MedlinePlus

Hamstring injury Overview A hamstring injury occurs when you strain or pull one of your hamstring muscles — the group of three muscles that run along ... You may be more likely to get a hamstring injury if you play soccer, basketball, football, tennis ...

Material costs of anterior cruciate ligament reconstruction with hamstring tendons by two different techniques.

PubMed

Cournapeau, J; Klouche, S; Hardy, P

2013-04-01

In France, approximately 36,000 anterior cruciate ligament (ACL) reconstruction surgical procedures are performed every year. Technical progress, in particular arthroscopy, has made surgery more precise, but more expensive. In a context of healthcare cost containment, the increase in the cost of technology must be compared to the improved outcome for the patients. The main aim of this study was to determine all material costs related to ACL reconstruction using hamstring tendons. This study also compared the material costs between the two arthroscopic techniques: standard or "all-inside". A retrospective study of material costs was performed in 2011. With the standard technique, the tibial tunnel was drilled from outside to inside, while with the all-inside technique two tunnels were drilled from inside to outside. All of the material used from the first swab to the final bandage was reported. It was classified into three categories: reusable arthroscopy material, disposable arthroscopic material, and disposable surgical supplies. The costs were those of our supplier in 2011 (Arthrex™) and based on Public Hospitals of Paris (AP-HP) public contract tariffs. Standard ligament reconstruction was less expensive than the all-inside technique: 791.59€ versus 931.06€ excluding taxes (hors taxes [HT]), respectively. The largest percentage of expenses was allocated to disposable material use (81 and 84%). Possible avenues of savings are limited: all the material used was necessary. To control costs, correct use and good maintenance of instruments are the most important elements. Level IV. Economic and decision analyses, retrospective study. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

One-stage Revision ACL reconstruction with hamstring autograft results in satisfactory outcome

PubMed Central

Kejriwal, Ritwik; Buelow, Jens

2017-01-01

Objectives: Revision anterior cruciate ligament (ACL) reconstruction is associated with poorer outcomes and higher rerupture rates when compared to primary ACL reconstruction. There is also a significant heterogeneity in surgical technique, number of stages, and graft options. We report a large single surgeon case series with hamstring autograft as a graft option. Methods: Observational series of revision ACL reconstructions performed by the senior author between 2005 and 2015 was carried out. Chart reviews and clinic follow-ups were performed with the following recorded – re-rupture rate, radiographic grading of osteoarthritis, KT-1000 arthrometer test, IKDC outcome scores and knee range of motion. All patients underwent single bundle four-strand hamstring autograft performed in one stage with use of new tunnels in majority of the cases. Results: 66 patients underwent hamstring autograft one-stage revision ACL reconstruction by Dr Jens Buelow. Chart review was carried out on all patients, and 26 (39%) were followed up in clinic and/or by phone with a mean follow up of 4.7 years. Outcomes included re-rupture rate of 4.5%, reoperation rate of 12%, mean visual analogue scale score of 7.6, mean side-to-side difference of 2.6 mm for KT-1000 arthrometer test, and mean IKDC score of 79. Of the 17 patients with radiographs, 40% had moderate osteoarthritis (grade 2 or 3) at follow-up. Conclusion: Revision ACL reconstruction can result in a satisfactory outcome when performed with a hamstring autograft in one stage.

Hamstring autograft versus soft-tissue allograft in anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomized controlled trials.

PubMed

Cvetanovich, Gregory L; Mascarenhas, Randy; Saccomanno, Maristella F; Verma, Nikhil N; Cole, Brian J; Bush-Joseph, Charles A; Bach, Bernard R

2014-12-01

To compare outcomes of anterior cruciate ligament (ACL) reconstruction with hamstring autograft versus soft-tissue allograft by systematic review and meta-analysis. A systematic review of randomized controlled studies comparing hamstring autograft with soft-tissue allograft in ACL reconstruction was performed. Studies were identified by strict inclusion and exclusion criteria. Descriptive statistics were reported. Where possible, the data were pooled and a meta-analysis was performed using RevMan software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). Dichotomous data were reported as risk ratios, whereas continuous data were reported as standardized mean differences and 95% confidence intervals. Heterogeneity was assessed by use of I(2) for each meta-analysis. Study methodologic quality was analyzed with the Modified Coleman Methodology Score and Jadad scale. Five studies with 504 combined patients (251 autograft and 253 allograft; 374 male and 130 female patients) with a mean age of 29.9 ± 2.2 years were included. The allografts used were fresh-frozen hamstring, irradiated hamstring, mixture of fresh-frozen and cryopreserved hamstring, fresh-frozen tibialis anterior, and fresh-frozen Achilles tendon grafts without bone blocks. The mean follow-up period was 47.4 ± 26.9 months, with a mean follow-up rate of 83.3% ± 8.6%. Two studies found a longer operative time with autograft than with allograft (77.1 ± 2.0 minutes v 59.9 ± 0.9 minutes, P = .008). Meta-analysis showed no statistically significant differences between autografts and allografts for any outcome measures (P > .05 for all tests). One study found significantly greater laxity for irradiated allograft than for autograft. The methodologic quality of the 5 studies was poor, with a mean Modified Coleman Methodology Score of 54.4 ± 6.9 and mean Jadad score of 1.6 ± 1.5. On the basis of this systematic review and meta-analysis of 5 randomized controlled trials, there is

Outcome of medial hamstring lengthening in children with spastic paresis: A biomechanical and morphological observational study

PubMed Central

Jaspers, Richard T.; Rutz, Erich; Harlaar, Jaap; van der Sluijs, Johannes A.; Witbreuk, Melinda M.; van Hutten, Kim; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald; Becher, Jules G.

2018-01-01

To improve gait in children with spastic paresis due to cerebral palsy or hereditary spastic paresis, the semitendinosus muscle is frequently lengthened amongst other medial hamstring muscles by orthopaedic surgery. Side effects on gait due to weakening of the hamstring muscles and overcorrections have been reported. How these side effects relate to semitendinosus morphology is unknown. This study assessed the effects of bilateral medial hamstring lengthening as part of single-event multilevel surgery (SEMLS) on (1) knee joint mechanics (2) semitendinosus muscle morphology and (3) gait kinematics. All variables were assessed for the right side only. Six children with spastic paresis selected for surgery to counteract limited knee range of motion were measured before and about a year after surgery. After surgery, in most subjects popliteal angle decreased and knee moment-angle curves were shifted towards a more extended knee joint, semitendinosus muscle belly length was approximately 30% decreased, while at all assessed knee angles tendon length was increased by about 80%. In the majority of children muscle volume of the semitendinosus muscle decreased substantially suggesting a reduction of physiological cross-sectional area. Gait kinematics showed more knee extension during stance (mean change ± standard deviation: 34±13°), but also increased pelvic anterior tilt (mean change ± standard deviation: 23±5°). In most subjects, surgical lengthening of semitendinosus tendon contributed to more extended knee joint angle during static measurements as well as during gait, whereas extensibility of semitendinosus muscle belly was decreased. Post-surgical treatment to maintain muscle belly length and physiological cross-sectional area may improve treatment outcome of medial hamstring lengthening. PMID:29408925

Outcome of medial hamstring lengthening in children with spastic paresis: A biomechanical and morphological observational study.

PubMed

Haberfehlner, Helga; Jaspers, Richard T; Rutz, Erich; Harlaar, Jaap; van der Sluijs, Johannes A; Witbreuk, Melinda M; van Hutten, Kim; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald; Becher, Jules G; Maas, Huub; Buizer, Annemieke I

2018-01-01

To improve gait in children with spastic paresis due to cerebral palsy or hereditary spastic paresis, the semitendinosus muscle is frequently lengthened amongst other medial hamstring muscles by orthopaedic surgery. Side effects on gait due to weakening of the hamstring muscles and overcorrections have been reported. How these side effects relate to semitendinosus morphology is unknown. This study assessed the effects of bilateral medial hamstring lengthening as part of single-event multilevel surgery (SEMLS) on (1) knee joint mechanics (2) semitendinosus muscle morphology and (3) gait kinematics. All variables were assessed for the right side only. Six children with spastic paresis selected for surgery to counteract limited knee range of motion were measured before and about a year after surgery. After surgery, in most subjects popliteal angle decreased and knee moment-angle curves were shifted towards a more extended knee joint, semitendinosus muscle belly length was approximately 30% decreased, while at all assessed knee angles tendon length was increased by about 80%. In the majority of children muscle volume of the semitendinosus muscle decreased substantially suggesting a reduction of physiological cross-sectional area. Gait kinematics showed more knee extension during stance (mean change ± standard deviation: 34±13°), but also increased pelvic anterior tilt (mean change ± standard deviation: 23±5°). In most subjects, surgical lengthening of semitendinosus tendon contributed to more extended knee joint angle during static measurements as well as during gait, whereas extensibility of semitendinosus muscle belly was decreased. Post-surgical treatment to maintain muscle belly length and physiological cross-sectional area may improve treatment outcome of medial hamstring lengthening.

Effects of Trypsinization and Mineralization on Intrasynovial Tendon Allograft Healing to Bone

PubMed Central

Qu, Jin; van Alphen, Nick A.; Thoreson, Andrew R.; Chen, Qingshan; An, Kai-Nan; Amadio, Peter C.; Schmid, Thomas M.; Zhao, Chunfeng

2014-01-01

The purpose of the current study was to develop a novel technology to enhance tendon-to-bone interface healing by trypsinizing and mineralizing (TM) an intrasynovial tendon allograft in a rabbit bone tunnel model. Eight rabbit flexor digitorum profundus (FDP) tendons were used to optimize the trypsinization process. An additional 24 FDP tendons were stratified into control and TM groups; in each group, 4 tendons were used for in vitro evaluation of TM and 8 were transplanted into proximal tibial bone tunnels in rabbits. The samples were evaluated histologically and with mechanical testing at postoperative week 8. Maximum failure strength and linear stiffness were not significantly different between the control and TM tendons. A thin fibrous band of scar tissue formed at the graft-to-bone interface in the control group. However, only the TM group showed obvious new bone formation inside the tendon graft and a visible fibrocartilage layer at the bone tunnel entrance. This study is the first to explore effects of TM on the intrasynovial allograft healing to a bone tunnel. TM showed beneficial effects on chondrogenesis, osteogenesis, and integration of the intrasynovial tendon graft, but mechanical strength was the same as the control tendons in this short-term in vivo study. PMID:25611186

Editorial Commentary: The Jury Remains Out on Hybrid Autograft-Plus-Allograft for Diminutive Hamstring Anterior Cruciate Ligament Autografts.

PubMed

Dhawan, Aman

2016-11-01

In a Level III, single center, retrospective, nonrandomized observational study, anterior cruciate ligament reconstruction revision rates and patient-reported outcomes were found to be similar at 2-year follow-up when using autograft hamstrings versus a hybrid graft (autograft and nonirradiated allograft), with both groups reporting low levels of revisions and excellent outcomes. Despite previous published data that were cause for concern, a study in this issue provides support for use of a hybrid graft technique when encountering the challenging situation of a diminutive hamstring autograft when performing anterior cruciate ligament reconstruction. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Effects of initial graft tension on femoral tunnel widening after anatomic anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft.

PubMed

Taketomi, Shuji; Inui, Hiroshi; Tahara, Keitaro; Shirakawa, Nobuyuki; Tanaka, Sakae; Nakagawa, Takumi

2017-09-01

The effects of initial graft tension upon tunnel widening (TW) following anatomic anterior cruciate ligament (ACL) reconstruction have not been elucidated. The purpose of this study was to retrospectively investigate the effect of two different graft-tensioning protocols upon femoral TW following anatomic ACL reconstruction using a bone-patellar tendon-bone (BPTB) graft and a three-dimensional (3D) computed tomography (CT) model. Forty-three patients who underwent isolated ACL reconstruction using BPTB grafts were included in this study. In 18 out of the 43 patients, the graft was fixed at full knee extension with manual maximum pull (Group H). These patients were compared with 25 patients in whom the BPTB graft was fixed at full knee extension with 80-N pull (Group L). Tunnel aperture area was measured using 3D CT 1 week and 1 year postoperatively, thus enabling us to calculate the percentage change in the area of femoral tunnel aperture. Clinical assessment was performed 1 year postoperatively, corresponding to the time period of CT assessment, and involved the evaluation of Lysholm score, anterior knee stability using a KneeLax3 arthrometer, and the pivot-shift test. When measured at 1 year postoperatively, the mean area of the femoral tunnel aperture had increased by 78.6 ± 36.8% in Group H when compared with at 1 week postoperatively, whereas that of Group L had increased by 27.7 ± 32.3%. Furthermore, TW (%) in Group H was significantly greater than that of Group L (P < 0.001). No significant differences were detected between the two groups with regard to any of the clinical outcomes evaluated. High levels of initial graft tension resulted in greater TW of the femoral tunnel aperture following anatomical ACL reconstruction using BPTB grafts. However, such levels of graft tension did not affect clinical outcome.

Comparison of clinical outcomes and second-look arthroscopic findings after ACL reconstruction using a hamstring autograft or a tibialis allograft.

PubMed

Yoo, Seung-Hyun; Song, Eun-Kyoo; Shin, Young-Rok; Kim, Sung-Kyu; Seon, Jong-Keun

2017-04-01

The purpose of this prospective randomized clinical study was to compare the clinical and radiological outcomes, including tibial tunnel widening and the progression of osteoarthritis after ACL reconstruction using a hamstring autograft or a tibialis allograft. In addition, we compared the graft tear and synovial coverage of grafts in patients that underwent the second-look arthroscopy. Among 184 patients with an ACL injury who underwent ACL reconstruction, 68 patients of autograft group and 64 patients of tibialis allograft group were included for this study after minimum of 2-year follow-up. The Lachman and pivot-shift tests, Tegner activity score, Lysholm knee score, and IKDC score were compared between the two groups. The quadriceps and hamstring isokinetic strengths using dynamometer were also compared. Degree of OA was determined using the Kellgren-Lawrence grading system on the weight-bearing radiographs. In total, 51 patients (26 patients in autograft group and 25 in the tibialis allograft group) underwent the second-look arthroscopy, in which we compared the apparent tear of graft and synovial coverage of grafts. At the final follow-up, there were no statistical significances in the two groups in Lachman and pivot-shift tests (n.s.). The Tegner activity, Lysholm knee score, and IKDC scores were similar in the two groups. Moreover, no significant differences were observed in the muscle power (n.s.). Some patients showed the progression of OA (five in autograft and four in allograft groups) without intergroup difference (n.s.). Regarding the findings of second-look arthroscopy, although there was no significant difference in graft tear, synovial coverage was better in autograft group than in allograft group. Even though hamstring autografts and tibialis allografts provided good functional outcomes without significant differences, the second-look arthroscopy revealed that hamstring autografts produced better synovial coverage than tibialis allograft. I.

Magnesium inference screw supports early graft incorporation with inhibition of graft degradation in anterior cruciate ligament reconstruction

PubMed Central

Cheng, Pengfei; Han, Pei; Zhao, Changli; Zhang, Shaoxiang; Zhang, Xiaonong; Chai, Yimin

2016-01-01

Patients after anterior cruciate ligament (ACL) reconstruction surgery commonly encounters graft failure in the initial phase of rehabilitation. The inhibition of graft degradation is crucial for the successful reconstruction of the ACL. Here, we used biodegradable high-purity magnesium (HP Mg) screws in the rabbit model of ACL reconstruction with titanium (Ti) screws as a control and analyzed the graft degradation and screw corrosion using direct pull-out tests, microCT scanning, and histological and immunohistochemical staining. The most noteworthy finding was that tendon graft fixed by HP Mg screws exhibited biomechanical properties substantially superior to that by Ti screws and the relative area of collagen fiber at the tendon-bone interface was much larger in the Mg group, when severe graft degradation was identified in the histological analysis at 3 weeks. Semi-quantitative immunohistochemical results further elucidated that the MMP-13 expression significantly decreased surrounding HP Mg screws with relatively higher Collagen II expression. And HP Mg screws exhibited uniform corrosion behavior without displacement or loosening in the femoral tunnel. Therefore, our results demonstrated that Mg screw inhibited graft degradation and improved biomechanical properties of tendon graft during the early phase of graft healing and highlighted its potential in ACL reconstruction. PMID:27210585

Magnesium inference screw supports early graft incorporation with inhibition of graft degradation in anterior cruciate ligament reconstruction

NASA Astrophysics Data System (ADS)

Cheng, Pengfei; Han, Pei; Zhao, Changli; Zhang, Shaoxiang; Zhang, Xiaonong; Chai, Yimin

2016-05-01

Patients after anterior cruciate ligament (ACL) reconstruction surgery commonly encounters graft failure in the initial phase of rehabilitation. The inhibition of graft degradation is crucial for the successful reconstruction of the ACL. Here, we used biodegradable high-purity magnesium (HP Mg) screws in the rabbit model of ACL reconstruction with titanium (Ti) screws as a control and analyzed the graft degradation and screw corrosion using direct pull-out tests, microCT scanning, and histological and immunohistochemical staining. The most noteworthy finding was that tendon graft fixed by HP Mg screws exhibited biomechanical properties substantially superior to that by Ti screws and the relative area of collagen fiber at the tendon-bone interface was much larger in the Mg group, when severe graft degradation was identified in the histological analysis at 3 weeks. Semi-quantitative immunohistochemical results further elucidated that the MMP-13 expression significantly decreased surrounding HP Mg screws with relatively higher Collagen II expression. And HP Mg screws exhibited uniform corrosion behavior without displacement or loosening in the femoral tunnel. Therefore, our results demonstrated that Mg screw inhibited graft degradation and improved biomechanical properties of tendon graft during the early phase of graft healing and highlighted its potential in ACL reconstruction.

Re-revision of a patellar tendon rupture in a young professional martial arts athlete.

PubMed

Vadalà, A; Iorio, R; Bonifazi, A M; Bolle, G; Ferretti, A

2012-09-01

A 27-year-old professional martial arts athlete experienced recurrent right knee patellar tendon rupture on three occasions. He underwent two operations for complete patellar tendon rupture: an end-to-end tenorrhaphy the first time, and revision with a bone-patellar-tendon (BPT) allograft. After the third episode, he was referred to our department, where we performed a surgical reconstruction with the use of hamstring pro-patellar tendon, in a figure-of-eight configuration, followed by a careful rehabilitation protocol. Clinical and radiological follow-ups were realized at 1, 3, and 6 months and 1 and 2 years postop, with an accurate physical examination, the use of recognized international outcome scores, and radiograph and MRI studies. As far as we know, this is the first paper to report a re-revision of a patellar tendon rupture.

Mechanisms of proximal hamstring rupture in a non-athlete healthy middle-aged female.

PubMed

Cotofana, Sebastian; Tillman, Bernhard; Pufe, Thomas; Lehrer, Selim; Watz, Dorothee; Zangl, Monika; Modlmayr, Harald; Knöckl, Ernest; Mahn, Hans-Joachim; Wambach, Werner

2012-09-01

To present an explicatory pathophysiological model for the rare clinical case of a total proximal hamstring rupture for the first time in the literature. A non-athletic healthy female (49 years) experienced a complete rupture of the right conjoint tendon of the biceps femoris (long head) and semitendinosus muscle while slipping down a lawn-covered slope (eccentric hip flexion and knee extension during stance phase of gait after heel-strike). A hamstring rupture was diagnosed by clinical examination and confirmed by magnet resonance imaging (MRI). Surgical reattachment of the conjoint tendon to the ischial tuberosity was performed. One year after surgery, she experienced no pain or functional impairment. Histological analysis and immune-histochemical staining (vascular endothelial growth factor - receptor 2) of a biopsy taken intra-operatively revealed signs of fibroblast proliferation and vasculoneogenesis with absence of inflammatory changes indicating that repairing mechanisms and tissue remodeling had been taking place. This case report provides evidence for the hypothesis that micro-injuries induce repairing mechanisms and thus tissue remodeling which leads to consecutive tissue weakening and mechanical failure during a non-adequate trauma. Micro-injuries can occur during leisure activities and remain clinically invisible until rupture. Copyright © 2012 Elsevier GmbH. All rights reserved.

Hamstring strain - aftercare

MedlinePlus

Pulled hamstring muscle; Sprain - hamstring ... There are 3 levels of hamstring strains: Grade 1 -- mild muscle strain or pull Grade 2 -- partial muscle tear Grade 3 -- complete muscle tear Recovery time depends ...

A review on animal models and treatments for the reconstruction of Achilles and flexor tendons.

PubMed

Bottagisio, Marta; Lovati, Arianna B

2017-03-01

Tendon is a connective tissue mainly composed of collagen fibers with peculiar mechanical properties essential to functional movements. The increasing incidence of tendon traumatic injuries and ruptures-associated or not with the loss of tissue-falls on the growing interest in the field of tissue engineering and regenerative medicine. The use of animal models is mandatory to deepen the knowledge of the tendon healing response to severe damages or acute transections. Thus, the selection of preclinical models is crucial to ensure a successful translation of effective and safe innovative treatments to the clinical practice. The current review is focused on animal models of tendon ruptures and lacerations or defective injuries with large tissue loss that require surgical approaches or grafting procedures. Data published between 2000 and 2016 were examined. The analyzed articles were compiled from Pub Med-NCBI using search terms, including animal model(s) AND tendon augmentation OR tendon substitute(s) OR tendon substitution OR tendon replacement OR tendon graft(s) OR tendon defect(s) OR tendon rupture(s). This article presents the existing preclinical models - considering their advantages and disadvantages-in which translational progresses have been made by using bioactive sutures or tissue engineering that combines biomaterials with cells and growth factors to efficiently treat transections or large defects of Achilles and flexor tendons.

Increased Risk of Revision After Anterior Cruciate Ligament Reconstruction With Soft Tissue Allografts Compared With Autografts: Graft Processing and Time Make a Difference.

PubMed

Maletis, Gregory B; Chen, Jason; Inacio, Maria C S; Love, Rebecca M; Funahashi, Tadashi T

2017-07-01

The optimal graft for anterior cruciate ligament reconstruction (ACLR) remains controversial. To compare the risk of aseptic revision between bone-patellar tendon-bone (BPTB) autografts, hamstring autografts, and soft tissue allografts. Cohort study; Level of evidence, 2. Prospectively collected ACLR cases reconstructed with BPTB autografts, hamstring autografts, and soft tissue allografts were identified using the Kaiser Permanente ACLR Registry. Aseptic revision was the endpoint. The type of graft and allograft processing method (nonprocessed, <1.8-Mrad irradiation with and without chemical processing [Allowash or AlloTrue], ≥1.8-Mrad irradiation with and without chemical processing, and chemical processing alone [BioCleanse]) were the exposures evaluated. Analyses were adjusted for age, sex, and race. Kaplan-Meier curves and Cox proportional hazards models were employed. The cohort included 14,015 cases: there were 8924 (63.7%) male patients, there were 6397 (45.6%) white patients, 4557 (32.5%) ACLRs used BPTB autografts, 3751 ACLRs (26.8%) used soft tissue allografts, and 5707 (40.7%) ACLRs used hamstring autografts. The median age was 34.6 years for soft tissue allografts, 24.3 years for hamstring autografts, and 22.0 years for BPTB autografts. The crude nonadjusted revision rates were 85 (1.9%) in BPTB autograft cases, 132 (2.3%) in hamstring autograft cases, and 83 (2.2%) in soft tissue allograft cases. After adjusting for age, sex, and race, compared with hamstring autografts, a higher risk of revision was found with allografts with ≥1.8 Mrad without chemical processing after 2.5 years (hazard ratio [HR], 3.88; 95% CI, 1.48-10.12) and ≥1.8 Mrad with chemical processing after 1 year (HR, 3.43; 95% CI, 1.58-7.47) and with BioCleanse processed grafts at any time point (HR, 3.02; 95% CI, 1.40-6.50). Nonprocessed allografts and those irradiated with <1.8 Mrad with or without chemical processing were not found to have a different risk of revision compared

Informing Stem Cell-Based Tendon Tissue Engineering Approaches with Embryonic Tendon Development.

PubMed

Okech, William; Kuo, Catherine K

Adult tendons fail to regenerate normal tissue after injury, and instead form dysfunctional scar tissue with abnormal mechanical properties. Surgical repair with grafts is the current standard to treat injuries, but faces significant limitations including pain and high rates of re-injury. To address this, we aim to regenerate new, normal tendons to replace dysfunctional tendons. A common approach to tendon tissue engineering is to design scaffolds and bioreactors based on adult tendon properties that can direct adult stem cell tenogenesis. Despite significant progress, advances have been limited due, in part, to a need for markers and potent induction cues. Our goal is to develop novel tendon tissue engineering approaches informed by embryonic tendon development. We are characterizing structure-property relationships of embryonic tendon to identify design parameters for three-dimensional scaffolds and bioreactor mechanical loading systems to direct adult stem cell tenogenesis. We will review studies in which we quantified changes in the mechanical and biochemical properties of tendon during embryonic development and elucidated specific mechanisms of functional property elaboration. We then examined the effects of these mechanical and biochemical factors on embryonic tendon cell behavior. Using custom-designed bioreactors, we also examined the effects of dynamic mechanical loading and growth factor treatment on embryonic tendon cells. Our findings have established cues to induce tenogenesis as well as metrics to evaluate differentiation. We finish by discussing how we have evaluated the tenogenic differentiation potential of adult stem cells by comparing their responses to that of embryonic tendon cells in these culture systems.

Estimation of tensile force in the hamstring muscles during overground sprinting.

PubMed

Ono, T; Higashihara, A; Shinohara, J; Hirose, N; Fukubayashi, T

2015-02-01

The purpose of this study was to identify the period of the gait cycle during which the hamstring muscles were likely injured by estimating the magnitude of tensile force in each muscle during overground sprinting. We conducted three-dimensional motion analysis of 12 male athletes performing overground sprinting at their maximal speed and calculated the hamstring muscle-tendon length and joint angles of the right limb throughout a gait cycle during which the ground reaction force was measured. Electromyographic activity during sprinting was recorded for the biceps femoris long head, semitendinosus, and semimembranosus muscles of ipsilateral limb. We estimated the magnitude of tensile force in each muscle by using the length change occurred in the musculotendon and normalized electromyographic activity value. The study found a quick increase of estimated tensile force in the biceps femoris long head during the early stance phase of the gait cycle during which the increased hip flexion angle and ground reaction force occurred at the same time. This study provides quantitative data of tensile force in the hamstring muscles suggesting that the biceps femoris long head muscle is susceptible to a strain injury during the early stance phase of the sprinting gait cycle. © Georg Thieme Verlag KG Stuttgart · New York.

The effect of screw taper on interference fit during load to failure at the soft tissue/bone interface.

PubMed

Mann, Charles J; Costi, John J; Stanley, Richard M; Dobson, Peter J

2005-10-01

The effect of screw geometry on the pullout strength of an anterior cruciate ligament reconstruction is well documented. The effect of a truly tapered screw has not been previously investigated. Thirty bovine knees in right and left knee pairs were collected. Superficial digital flexors from the hind legs of sheep were harvested to form a quadruple tendon graft. For each knee pair, one tendon graft was fixed using a tapered screw (n=15) and the other with a non-tapered screw (n=15). Interference screws were manufactured from stainless steel, and apart from the tapered or non-tapered profile were identical. The screws were inserted into a tibial tunnel already containing the tendon graft. The interference fit was tested by extensile load to failure tests. The insertion torque of the screws and first sign of load to failure (by pullout) of the interference fit were recorded. Results were analysed using paired t-tests. The results indicated that tapered screws have significantly higher resistance to interference failure (p=0.007) and insertion torque (p<0.001) than non-tapered screws. The improved biomechanical performance of tapered screws demonstrated in this study may translate into superior clinical results, particularly at the tibial attachment of hamstring anterior cruciate ligament reconstruction, and also of hamstring fixation to the medial femoral condyle for patella instability.

Chronic triceps insufficiency managed with extensor carpi radialis longus and palmaris longus tendon grafts.

PubMed

Singh, Dhanpal; Kumar, K Arun; Dinesh, Mc; Raj, Ranju

2012-03-01

Chronic triceps insufficiency, causing prolonged disability, occurs due to a missed diagnosis of an acute rupture. We report a 25 year old male with history of a significant fall sustaining multiple injuries. Since then, he had inability in extending his right elbow for which he sought intervention after a year. Diagnosis of triceps rupture was made clinicoradiologically and surgery was planned. Intraoperative findings revealed a deficient triceps with a fleck of avulsed bone from olecranon. Ipsilateral double tendon graft including extensor carpi radialis longus and palmaris longus were anchored to triceps and secured with the olecranon. Six-months follow revealed a complete active extension of elbow and a full function at the donor site.

Acute first-time hamstring strains during slow-speed stretching: clinical, magnetic resonance imaging, and recovery characteristics.

PubMed

Askling, Carl M; Tengvar, Magnus; Saartok, Tönu; Thorstensson, Alf

2007-10-01

Hamstring strains can be of 2 types with different injury mechanisms, 1 occurring during high-speed running and the other during stretching exercises. A stretching type of injury to the proximal rear thigh may involve specific muscle-tendon structures that could affect recovery time. Case series (prognosis); Level of evidence, 2. Fifteen professional dancers with acute first-time hamstring strains were prospectively included in the study. All subjects were examined, clinically and with magnetic resonance imaging, on 4 occasions after injury: at day 2 to 4, 10, 21, and 42. The clinical follow-up period was 2 years. All dancers were injured during slow hip-flexion movements with extended knee and experienced relatively mild acute symptoms. All injuries were located proximally in the posterior thigh close to the ischial tuberosity. The injury involved the semimembranosus (87%), quadratus femoris (87%), and adductor magnus (33%). All injuries to the semimembranosus involved its proximal free tendon. There were no significant correlations between clinical or magnetic resonance imaging parameters and the time to return to preinjury level (median, 50 weeks; range, 30-76 weeks). Stretching exercises can give rise to a specific type of strain injury to the posterior thigh. A precise history and careful palpation provide the clinician enough information to predict a prolonged time until return to preinjury level. One factor underlying prolonged recovery time could be the involvement of the free tendon of the semimembranosus muscle.

Arthroscopic assisted tendon reconstruction for triangular fibrocartilage complex irreparable tears.

PubMed

Luchetti, R; Atzei, A

2017-05-01

We report our 11-year experience of performing arthroscopically assisted triangular fibrocartilage complex reconstruction in the treatment of chronic distal radio-ulnar joint instability resulting from irreparable triangular fibrocartilage complex injuries. Eleven patients were treated. Three skin incisions were made in order to create radial and ulna tunnels for passage of the tendon graft, which is used to reconstruct the dorsal and palmar radio-ulnar ligaments, under fluoroscopic and arthroscopic guidance. At a mean follow-up of 68 months all but one had a stable distal radio-ulnar joint. Pain and grip strength, Mayo wrist score, Disability of the Arm Hand and Shoulder and patient-rated wrist and hand evaluation scores improved. The ranges of forearm rotation remained largely unchanged. Complications included an early tendon graft tear, two late-onset graft ruptures, one ulna styloid fracture during surgery and persistent wrist discomfort during forearm rotation requiring tendon graft revision in one case. An arthroscopic assisted approach for triangular fibrocartilage complex reconstruction appears safe and produces comparable results with the open technique. IV.

National Football League athletes' return to play after surgical reattachment of complete proximal hamstring ruptures.

PubMed

Mansour, Alfred A; Genuario, James W; Young, Jason P; Murphy, Todd P; Boublik, Martin; Schlegel, Theodore F

2013-06-01

Although hamstring strains are common among professional football players, proximal tendon avulsions are relatively rare. Surgical repair is recommended, but there is no evidence on professional football players return to play (RTP). We hypothesized that surgical reattachment of complete proximal hamstring ruptures in these athletes would enable successful RTP. Ten proximal hamstring avulsions were identified in 10 National Football League (NFL) players between 1990 and 2008. Participating team physicians retrospectively reviewed each player's training room and clinical records, operative notes, and imaging studies. The ruptures were identified and confirmed with magnetic resonance imaging. Of the 10 injuries, 9 had palpable defects. Each of the ruptures was managed with surgical fixation within 10 days of injury. All of the players reported full return of strength and attempted to resume play at the beginning of the following season, with 9 of the 10 actually returning to play. However, despite having no limitations related to the surgical repair, only 5 of the 10 athletes played in more than 1 game. Most NFL players who undergo acute surgical repair of complete proximal hamstring ruptures are able to RTP, but results are mixed regarding long-term participation. This finding may indicate that this injury is a marker for elite-level physical deterioration.

No Relationship Between Hamstring Flexibility and Hamstring Injuries in Male Amateur Soccer Players: A Prospective Study.

PubMed

van Doormaal, Mitchell C M; van der Horst, Nick; Backx, Frank J G; Smits, Dirk-Wouter; Huisstede, Bionka M A

2017-01-01

In soccer, although hamstring flexibility is thought to play a major role in preventing hamstring injuries, the relationship between hamstring flexibility and hamstring injuries remains unclear. To investigate the relationship between hamstring flexibility and hamstring injuries in male amateur soccer players. Case-control study; Level of evidence, 3. This study included 450 male first-class amateur soccer players (mean age, 24.5 years). Hamstring flexibility was measured by performing the sit-and-reach test (SRT). The relationship between hamstring flexibility and the occurrence of hamstring injuries in the following year, while adjusting for the possible confounding effects of age and previous hamstring injuries, was determined with a multivariate logistic regression analysis. Of the 450 soccer players, 21.8% reported a hamstring injury in the previous year. The mean (±SD) baseline score for the SRT was 21.2 ± 9.2 cm. During the 1-year follow-up period, 23 participants (5.1%) suffered a hamstring injury. In the multivariate analysis, while adjusting for age and previous injuries, no significant relationship was found between hamstring flexibility and hamstring injuries ( P = .493). In this group of soccer players, hamstring flexibility (measured with the SRT) was not related to hamstring injuries. Age and previous hamstring injuries as possible confounders did not appear to influence this relationship. Other etiological factors need to be examined to further elucidate the mechanism of hamstring injuries.

Osteointegration of soft tissue grafts within the bone tunnels in anterior cruciate ligament reconstruction can be enhanced.

PubMed

Kuang, Guan-Ming; Yau, W P; Lu, William W; Chiu, K Y

2010-08-01

Anterior cruciate ligament reconstruction with a soft tissue autograft (hamstring autograft) has grown in popularity in the last 10 years. However, the issues of a relatively long healing time and an inferior histological healing result in terms of Sharpey-like fibers connection in soft tissue grafts are still unsolved. To obtain a promising outcome in the long run, prompt osteointegration of the tendon graft within the bone tunnel is essential. In recent decades, numerous methods have been reported to enhance osteointegration of soft tissue graft in the bone tunnel. In this article, we review the current literature in this research area, mainly focusing on strategies applied to the local bone tunnel environment. Biological strategies such as stem cell and gene transfer technology, as well as the local application of specific growth factors have been reported to yield exciting results. The use of biological bone substitute and physical stimulation also obtained promising results. Artificially engineered tissue has promise as a solution to the problem of donor site morbidity. Despite these encouraging results, the current available evidence is still experimental. Further clinical studies in terms of randomized control trial in the future should be conducted to extrapolate these basic science study findings into clinical practice.

Effects of a peracetic acid disinfection protocol on the biocompatibility and biomechanical properties of human patellar tendon allografts.

PubMed

Lomas, R J; Jennings, L M; Fisher, J; Kearney, J N

2004-01-01

Patellar tendon allografts, retrieved from cadaveric human donors, are widely used for replacement of damaged cruciate ligaments. In common with other tissue allografts originating from cadaveric donors, there are concerns regarding the potential for disease transmission from the donor to the recipient. Additionally, retrieval and subsequent processing protocols expose the graft to the risk of environmental contamination. For these reasons, disinfection or sterilisation protocols are necessary for these grafts before they are used clinically. A high-level disinfection protocol, utilising peracetic acid (PAA), has been developed and investigated for its effects on the biocompatibility and biomechanics of the patellar tendon allografts. PAA disinfection did not render the grafts either cytotoxic or liable to provoke an inflammatory response as assessed in vitro . However, the protocol was shown to increase the size of gaps between the tendon fibres in the matrix and render the grafts more susceptible to digestion with collagenase. Biomechanical studies of the tendons showed that PAA treatment had no effect on the ultimate tensile stress or Young's modulus of the tendons, and that ultimate strain was significantly higher in PAA treated tendons.

Sterilization with electron beam irradiation influences the biomechanical properties and the early remodeling of tendon allografts for reconstruction of the anterior cruciate ligament (ACL).

PubMed

Schmidt, Tanja; Hoburg, Arnd; Broziat, Christine; Smith, Mark D; Gohs, Uwe; Pruss, Axel; Scheffler, Sven

2012-08-01

Although allografts for anterior cruciate ligament (ACL) replacement have shown advantages compared to autografts, their use is limited due to the risk of disease transmission and the limitations of available sterilization methods. Gamma sterilization has shown detrimental effects on graft properties at the high doses required for sufficient pathogen inactivation. In our previous in vitro study on human patellar tendon allografts, Electron beam (Ebeam) irradiation showed less detrimental effects compared to gamma sterilization (Hoburg et al. in Am J Sports Med 38(6):1134-1140, 2010). To investigate the biological healing and restoration of the mechanical properties of a 34 kGy Ebeam treated tendon allograft twenty-four sheep underwent ACL replacement with either a 34 kGy Ebeam treated allograft or a non-sterilized fresh frozen allograft. Biomechanical testing of stiffness, ultimate failure load and AP-laxity as well as histological analysis to investigate cell, vessel and myofibroblast-density were performed after 6 and 12 weeks. Native sheep ACL and hamstring tendons (HAT, each n = 9) served as controls. The results of a previous study analyzing the remodeling of fresh frozen allografts (n = 12) and autografts (Auto, n = 18) with the same study design were also included in the analysis. Statistics were performed using Mann-Whitney U test followed by Bonferroni-Holm correction. Results showed significantly decreased biomechanical properties during the early remodeling period in Ebeam treated grafts and this was accompanied with an increased remodeling activity. There was no recovery of biomechanical function from 6 to 12 weeks in this group in contrast to the results observed in fresh frozen allografts and autografts. Therefore, high dose Ebeam irradiation investigated in this paper cannot be recommended for soft tissue allograft sterilization.

Magnetic resonance neurography evaluation of chronic extraspinal sciatica after remote proximal hamstring injury: a preliminary retrospective analysis.

PubMed

Bucknor, Matthew D; Steinbach, Lynne S; Saloner, David; Chin, Cynthia T

2014-08-01

Extraspinal sciatica can present unique challenges in clinical diagnosis and management. In this study, the authors evaluated qualitative and quantitative patterns of sciatica-related pathology at the ischial tuberosity on MR neurography (MRN) studies performed for chronic extraspinal sciatica. Lumbosacral MRN studies obtained in 14 patients at the University of California, San Francisco between 2007 and 2011 were retrospectively reviewed. The patients had been referred by neurosurgeons or neurologists for chronic unilateral sciatica (≥ 3 months), and the MRN reports described asymmetrical increased T2 signal within the sciatic nerve at the level of the ischial tuberosity. MRN studies were also performed prospectively in 6 healthy volunteers. Sciatic nerve T2 signal intensity (SI) and cross-sectional area at the ischial tuberosity were calculated and compared between the 2 sides in all 20 subjects. The same measurements were also performed at the sciatic notch as an internal reference. Adjacent musculoskeletal pathology was compared between the 2 sides in all subjects. Seven of the 9 patients for whom detailed histories were available had a specific history of injury or trauma near the proximal hamstring preceding the onset of sciatica. Eight of the 14 patients also demonstrated soft-tissue abnormalities adjacent to the proximal hamstring origin. The remaining 6 had normal muscles, tendons, and marrow in the region of the ischial tuberosity. There was a significant difference in sciatic nerve SI and size between the symptomatic and asymptomatic sides at the level of the ischial tuberosity, with a mean adjusted SI of 1.38 compared with 1.00 (p < 0.001) and a mean cross-sectional nerve area of 0.66 versus 0.54 cm(2) (p = 0.002). The control group demonstrated symmetrical adjusted SI and sciatic nerve size. This study suggests that chronic sciatic neuropathy can be seen at the ischial tuberosity in the setting of prior proximal hamstring tendon injury or adjacent

Tension degradation of anterior cruciate ligament grafts with dynamic flexion-extension loading: a biomechanical model in porcine knees.

PubMed

Dargel, Jens; Koebke, Jürgen; Brüggemann, Gert-Peter; Pennig, Dietmar; Schmidt-Wiethoff, Rüdiger

2009-10-01

This study investigates the influence of various femoral anterior cruciate ligament graft fixation methods on the amount of tension degradation and the initial fixation strength after cyclic flexion-extension loading in a porcine knee model. One hundred twenty porcine digital extensor tendons, used as 4-stranded free tendon grafts, were fixated within porcine femoral bone tunnels by use of extracortical button, cross-pin, or interference screw fixation. One hundred twenty porcine patellar tendon-bone grafts were fixated by use of cross-pin, interference screw, or press-fit fixation. Each femur-graft complex was submitted to cyclic flexion-extension loading for 1,000 cycles throughout different loading ranges, and the total loss of tension was determined. After cyclic testing, the grafts were loaded to failure, and the data were compared with a pullout series without cyclic loading. Tension degradation after 1,000 cycles of flexion-extension loading averaged 62.6% +/- 10.0% in free tendon grafts and 48.9% +/- 13.35% in patellar tendon-bone grafts. There was no influence of the loading range on the total amount of tension degradation. The total amount of tension degradation was the highest with interference screw fixation of free tendon and patellar tendon-bone grafts. Despite excessive loss of tension, the initial fixation strength of the femur-graft complex was not reduced. The method of femoral graft fixation significantly influenced tension degradation during dynamic flexion-extension loading. Femoral graft fixation methods that secure the graft close to the tunnel entrance and that displace the graft substance from the center of the bone tunnel show the largest amount of tension degradation during cyclic flexion-extension loading. The graft substance, not the fixation site, was the weakest link of the graft complex within this investigation. We believe that the graft fixation method should be considered when aiming to improve the precision of femoral graft

Autograft versus nonirradiated allograft tissue for anterior cruciate ligament reconstruction: a systematic review.

PubMed

Mariscalco, Michael W; Magnussen, Robert A; Mehta, Divyesh; Hewett, Timothy E; Flanigan, David C; Kaeding, Christopher C

2014-02-01

An autograft has traditionally been the gold standard for anterior cruciate ligament reconstruction (ACLR), but the use of allograft tissue has increased in recent years. While numerous studies have demonstrated that irradiated allografts are associated with increased failure rates, some report excellent results after ACLR with nonirradiated allografts. The purpose of this systematic review was to determine whether the use of nonirradiated allograft tissue is associated with poorer outcomes when compared with autografts. Patients undergoing ACLR with autografts versus nonirradiated allografts will demonstrate no significant differences in graft failure risk, laxity on postoperative physical examination, or differences in patient-oriented outcome scores. Systematic review. A systematic review was performed to identify prospective or retrospective comparative studies (evidence level 1, 2, or 3) of autografts versus nonirradiated allografts for ACLR. Outcome data included graft failure based on clinical findings and instrumented laxity, postoperative laxity on physical examination, and patient-reported outcome scores. Studies were excluded if they did not specify whether the allograft had been irradiated. Quality assessment and data extraction were performed by 2 examiners. Nine studies comparing autografts and nonirradiated allografts were included. Six of the 9 studies compared bone-patellar tendon-bone (BPTB) autografts with BPTB allografts. Two studies compared hamstring tendon autografts to hamstring tendon allografts, and 1 study compared hamstring tendon autografts to tibialis anterior allografts. The mean patient age in 7 of 9 studies ranged from 24.5 to 32 years, with 1 study including only patients older than 40 years and another not reporting patient age. The mean follow-up duration was 24 to 94 months. Six of 9 studies reported clinical graft failure rates, 8 of 9 reported postoperative instrumented laxity measurements, 7 of 9 reported postoperative

Lower eccentric hamstring strength and single leg hop for distance predict hamstring injury in PETE students.

PubMed

Goossens, L; Witvrouw, E; Vanden Bossche, L; De Clercq, D

2015-01-01

Hamstring injuries have not been under research in physical education teacher education (PETE) students so far. Within the frame of the development of an injury prevention program, for this study we conducted an analysis of modifiable risk factors for hamstring injuries in PETE students. Hamstring injuries of 102 freshmen bachelor PETE students were registered prospectively during one academic year. Eighty-one students completed maximum muscle strength tests of hip extensors, hamstrings, quadriceps (isometric) and hamstrings (eccentric) at the start of the academic year. Sixty-nine of the latter completed a single leg hop for distance (SLHD). Risk factors for hamstring injuries were statistically detected using logistic regression. Sixteen hamstring injuries (0.16 injuries/student/academic year; 0.46 injuries/1000 h) occurred to 10 participants. Eight cases were included in the risk factor analysis. Lower eccentric hamstring strength (odds ratio (ODD) = 0.977; p = 0.043), higher isometric/eccentric hamstring strength ratio (ODD = 970.500; p = 0.019) and lower score on the SLHD (ODD = 0.884; p = 0.005) were significant risk factors for hamstring injury. A combination of eccentric hamstring strength test and SLHD could give a good risk analysis of hamstring injuries in PETE students. This might offer great perspectives for easily applicable screening in a clinical setting.

Functional Outcomes and Return to Sports After Acute Repair, Chronic Repair, and Allograft Reconstruction for Proximal Hamstring Ruptures.

PubMed

Rust, David A; Giveans, M Russell; Stone, Rebecca M; Samuelson, Kathryn M; Larson, Christopher M

2014-06-01

There are limited data regarding outcomes and return to sports after surgery for acute versus chronic proximal hamstring ruptures. Surgery for chronic proximal hamstring ruptures leads to improved outcomes and return to sports but at a lower level than with acute repair. Proximal hamstring reconstruction with an Achilles allograft for chronic ruptures is successful when direct repair is not possible. Cohort study; Level of evidence, 3. Between 2002 and 2012, a total of 72 patients with a traumatic proximal hamstring rupture (51 acute, 21 chronic) underwent either direct tendon repair with suture anchors (n = 58) or Achilles allograft tendon reconstruction (n = 14). Results from the Single Assessment Numeric Evaluation (SANE) for activities of daily living (ADL) and sports-related activities, Short Form-12 (SF-12), visual analog scale (VAS), and a patient satisfaction questionnaire were obtained. The mean time to surgery in the chronic group was 441.4 days versus 17.8 days in the acute group. At a mean follow-up of 45 months, patients with chronic tears had inferior sports activity scores (70.2% vs 80.3%, respectively; P = .026) and a trend for decreased ADL scores (86.5% vs 93.3%, respectively; P = .085) compared with those with acute tears. Patients with chronic tears, however, reported significant improvements postoperatively for both sports activity scores (30.3% to 70.2%; P < .01) and ADL scores (56.1% to 86.5%; P < .01). Greater than 5 to 6 cm of retraction in the chronic group was predictive of the need for allograft reconstruction (P = .015) and resulted in ADL and sports activity scores equal to those of chronic repair (P = .507 and P = .904, respectively). There were no significant differences between groups in SF-12, VAS, or patient satisfaction outcomes (mean, 85.2% satisfaction overall). Acute repair was superior to chronic surgery with regard to return to sports. Acute and chronic proximal hamstring repair and allograft reconstruction had favorable

The biomechanical strength of a hardware-free femoral press-fit method for ACL bone-tendon-bone graft fixation.

PubMed

Arnold, M P; Burger, L D; Wirz, D; Goepfert, B; Hirschmann, M T

2017-04-01

The purpose was to investigate graft slippage and ultimate load to failure of a femoral press-fit fixation technique for anterior cruciate ligament (ACL) reconstruction. Nine fresh-frozen knees were used. Standardized harvesting of the B-PT-B graft was performed. The femora were cemented into steel rods, and a tunnel was drilled outside-in into the native ACL footprint and expanded using a manual mill bit. The femoral bone block was fixed press-fit. To pull the free end of the graft, it was fixed to a mechanical testing machine using a deep-freezing technique. A motion capture system was used to assess three-dimensional micro-motion. After preconditioning of the graft, 1000 cycles of tensile loading were applied. Finally, an ultimate load to failure test was performed. Graft slippage in mm ultimate load to failure as well as type of failure was noted. In six of the nine measured specimens, a typical pattern of graft slippage was observed during cyclic loading. For technical reasons, the results of three knees had to be discarded. 78.6 % of total graft slippage occurred in the first 100 cycles. Once the block had settled, graft slippage converged to zero, highlighting the importance of initial preconditioning of the graft in the clinical setting. Graft slippage after 1000 cycles varied around 3.4 ± 3.2 mm (R = 1.3-9.8 mm) between the specimens. Ultimate loading (n = 9) revealed two characteristic patterns of failure. In four knees, the tendon ruptured, while in five knees the bone block was pulled out of the femoral tunnel. The median ultimate load to failure was 852 N (R = 448-1349 N). The implant-free femoral press-fit fixation provided adequate primary stability with ultimate load to failure pull forces at least equal to published results for interference screws; hence, its clinical application is shown to be safe.

COMPARISON OF HAMSTRING MUSCLE ACTIVATION DURING HIGH-SPEED RUNNING AND VARIOUS HAMSTRING STRENGTHENING EXERCISES

PubMed Central

Solheim, Jens Asmund Brevik; Bencke, Jesper

2017-01-01

Purpose/Background Several studies have examined the effect of hamstring strength exercises upon hamstring strains in team sports that involve many sprints. However, there has been no cross comparison among muscle activation of these hamstring training exercises with actual sprinting. Therefore, the aim of this study was to examine different hamstring exercises and compare the muscle activity in the hamstring muscle group during various exercises with the muscular activity produced during maximal sprints. Methods Twelve male sports students (age 25 ± 6.2 years, 1.80 ± 7.1 m, body mass 81.1 ± 15.6 kg) participated in this study. Surface EMG electrodes were placed on semimembranosus, semitendinosus and biceps femoris to measure muscle activity during seven hamstrings exercises and sprinting together with 3D motion capture to establish at what hip and knee angles maximal muscle activation (EMG) occurs. Maximal EMG activity during sprints for each muscle was used in order to express each exercise as a percentage of max activation during sprinting. Results The main findings were that maximal EMG activity of the different hamstring exercises were on average between 40-65% (Semitendinosus), 18-40% (biceps femoris) and 40-75% (Semimembranosus) compared with the max EMG activity in sprints, which were considered as 100%. The laying kick together with the Nordic hamstring exercises and its variations had the highest muscle activations, while the cranes showed the lowest muscle activation (in all muscles) together with the standing kick for the semimembranosus. In addition, angles at which the peak EMG activity of the hamstring muscle occurs were similar for the Nordic hamstring exercises and different for the two crane exercises (hip angle), standing kick (hip angle) and the laying kick (knee angle) compared with the sprint. Conclusions Nordic hamstring exercises with its variation together with the laying kick activates the hamstrings at high levels and

Tension Regulation at the Suture Lines for Repair of Neglected Achilles Tendon Laceration.

PubMed

Massoud, Elsayed Ibraheem Elsayed

2017-03-01

Operative intervention is the preferred option for management of the neglected laceration of the Achilles tendon. However, the commonly used techniques rarely follow the principles of the regenerative medicine for the restoration of the lost tissue. This study postulated that incorporation of the autogenous tendon graft would properly progress when the interplay between mechanical loading and healing phases was correctly applied. A prospective study included 15 patients who were treated for neglected Achilles tendon laceration using the technique of lengthening of the proximal tendon stump. An absorbable reinforcement suture was used for control of the mechanical environment at the suture lines. By an average 5 years of the prospective follow-up, all the repaired tendons had restored continuity and length. The calf circumference equalized to the uninjured side in 12 patients. However, 3 patients had calf atrophy but they improved compared to the preoperative measurements. Sonogram confirmed the restoration of the normal thickness and the gliding characteristics of the repaired tendon. The technique restored continuity and tension of the repaired tendon, preserved the calf circumference, and prevented peritendinous adhesions. The absorbable reinforcement suture spontaneously allowed for the mechanical loading of the grafted tendon. Level IV, case series.

Treatment of chronic Achilles tendon rupture by shortening suture and free sural triceps aponeurosis graft.

PubMed

Khiami, F; Di Schino, M; Sariali, E; Cao, D; Rolland, E; Catonné, Y

2013-09-01

The Bosworth technique is old but still widely used. It involves problems of precisely determining the length of the Achilles tendon and of a volume effect in the turndown area. A new reconstruction technique is assessed, based on free sural triceps aponeurosis transfer without turndown, associated to tendon shortening suture. Twenty-three patients were assessed by AOFAS score and clinical examination (plus MRI in 14 cases) at a mean 24.5 months' follow-up. Mean age was 52.1 years. Mean pre-operative AOFAS score was 63.6/100. Mean postoperative AOFAS score was 96.1. Mean graft length was 7.5 cm. Surgical revision was required for one case of postoperative infection. Twelve patients resumed leisure sports at their previous level by a mean 9.4 ± 2 months; three competitive sportsmen resumed sport at their previous level by a mean 7.6 months. None were dissatisfied or disappointed with their operation. MRI performed at 1 year found increased tendon volume without abnormality in 57% of cases; 43% showed abnormal images. Functional results were comparable to literature reports. It can be difficult to determine Achilles length for the Bosworth technique: this is made easier by conserving a fibrous support of a length determined with reference to the healthy side. The technique avoids aponeurosis turndown, and thus avoids the problem of plasty volume effect. The two cases of cutaneous complication occurred in the two most elderly patients, raising the question of the indications for reconstructive surgery in the elderly. The abnormalities found on MRI concerned scar tissue remodeling in patients with good or excellent clinical results. Level IV, retrospective study. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Comparison of Autograft and Allograft with Surface Modification for Flexor Tendon Reconstruction: A Canine in Vivo Model.

PubMed

Wei, Zhuang; Reisdorf, Ramona L; Thoreson, Andrew R; Jay, Gregory D; Moran, Steven L; An, Kai-Nan; Amadio, Peter C; Zhao, Chunfeng

2018-04-04

Flexor tendon injury is common, and tendon reconstruction is indicated clinically if the primary repair fails or cannot be performed immediately after tendon injury. The purpose of the current study was to compare clinically standard extrasynovial autologous graft (EAG) tendon and intrasynovial allogeneic graft (IAG) that had both undergone biolubricant surface modification in a canine in vivo model. Twenty-four flexor digitorum profundus (FDP) tendons from the second and fifth digits of 12 dogs were used for this study. In the first phase, a model of failed FDP tendon repair was created. After 6 weeks, the ruptured FDP tendons with a scarred digit were reconstructed with the use of either EAG or IAG tendons treated with carbodiimide-derivatized hyaluronic acid and lubricin. At 12 weeks after tendon reconstruction, the digits were harvested for functional, biomechanical, and histologic evaluations. The tendon failure model was a clinically relevant and reproducible model for tendon reconstruction. The IAG group demonstrated improved digit function with decreased adhesion formation, lower digit work of flexion, and improved graft gliding ability compared with the EAG group. However, the IAG group had decreased healing at the distal tendon-bone junction. Our histologic findings verified the biomechanical evaluations and, further, showed that cellular repopulation of allograft at 12 weeks after reconstruction is still challenging. FDP tendon reconstruction using IAG with surface modification has some beneficial effects for reducing adhesions but demonstrated inferior healing at the distal tendon-bone junction compared with EAG. These mixed results indicate that vitalization and turnover acceleration are crucial to reducing failure of reconstruction with allograft. Flexor tendon reconstruction is a common surgical procedure. However, postoperative adhesion formation may lead to unsatisfactory clinical outcomes. In this study, we developed a potential flexor tendon

A Biomechanical Comparison of Allograft Tendons for Ligament Reconstruction.

PubMed

Palmer, Jeremiah E; Russell, Joseph P; Grieshober, Jason; Iacangelo, Abigail; Ellison, Benjamin A; Lease, T Dylan; Kim, Hyunchul; Henn, R Frank; Hsieh, Adam H

2017-03-01

Allograft tendons are frequently used for ligament reconstruction about the knee, but they entail availability and cost challenges. The identification of other tissues that demonstrate equivalent performance to preferred tendons would improve limitations. Hypothesis/Purpose: We compared the biomechanical properties of 4 soft tissue allograft tendons: tibialis anterior (TA), tibialis posterior (TP), peroneus longus (PL), and semitendinosus (ST). We hypothesized that allograft properties would be similar when standardized by the looped diameter. Controlled laboratory study. This study consisted of 2 arms evaluating large and small looped-diameter grafts: experiment A consisted of TA, TP, and PL tendons (n = 47 each) with larger looped diameters of 9.0 to 9.5 mm, and experiment B consisted of TA, TP, PL, and ST tendons (n = 53 each) with smaller looped diameters of 7.0 to 7.5 mm. Each specimen underwent mechanical testing to measure the modulus of elasticity (E), ultimate tensile force (UTF), maximal elongation at failure, ultimate tensile stress (UTS), and ultimate tensile strain (UTε). Experiment A: No significant differences were noted among tendons for UTF, maximal elongation at failure, and UTϵ. UTS was significantly higher for the PL (54 MPa) compared with the TA (44 MPa) and TP (43 MPa) tendons. E was significantly higher for the PL (501 MPa) compared with the TP (416 MPa) tendons. Equivalence testing showed that the TP and PL tendon properties were equivalent or superior to those of the TA tendons for all outcomes. Experiment B: All groups exhibited a similar E. UTF was again highest in the PL tendons (2294 N) but was significantly different from only the ST tendons (1915 N). UTϵ was significantly higher for the ST (0.22) compared with the TA (0.19) and TP (0.19) tendons. Equivalence testing showed that the TA, TP, and PL tendon properties were equivalent or superior to those of the ST tendons. Compared with TA tendons, TP and PL tendons of a given looped

Are the hamstrings from the drive leg or landing leg more active in baseball pitchers? An electromyographic study.

PubMed

Erickson, Brandon J; Zaferiou, Antonia; Chalmers, Peter N; Ruby, Deana; Malloy, Phillip; Luchetti, Timothy J; Verma, Nikhil N; Romeo, Anthony A

2017-11-01

Ulnar collateral ligament reconstruction (UCLR) has become a common procedure among baseball players of all levels. There are several graft choices in performing UCLR, one of which is a hamstring (gracilis or semitendinosus) autograft. It is unclear whether the hamstring muscle from a pitcher's drive leg (ipsilateral side of the UCLR) or landing leg (contralateral side of the UCLR) is more active during the pitching motion. We hypothesized that the landing leg semitendinosus will be more electromyographically active than the drive leg. Healthy, elite male pitchers aged 16-21 years were recruited. Sixteen pitchers (average age, 17.6 ± 1.6 years; 67% threw right handed) underwent electromyographic analysis. Pitchers threw 5 fastballs at 100% effort from the wind-up with electromyographic analysis of every pitch. Activation of the semitendinosus and biceps femoris in both legs was compared within pitchers and between pitchers. Hamstring activity was higher in the drive leg than in the landing leg during each phase and in sum, although the difference was significant only during the double support phase (P = .021). On within-pitcher analysis, 10 of 16 pitchers had significantly more sum hamstring activity in the drive leg than in the landing leg, while only 4 of 16 had more activity in the landing leg (P = .043). During the baseball pitch, muscle activity of the semitendinosus was higher in the drive leg than in the landing leg in most pitchers. Surgeons performing UCLR using hamstring autograft should consider harvesting the graft from the pitcher's landing leg to minimize disruption to the athlete's pitching motion. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Kartogenin with PRP promotes the formation of fibrocartilage zone in the tendon-bone interface.

PubMed

Zhou, Yiqin; Zhang, Jianying; Yang, Jinsong; Narava, Manoj; Zhao, Guangyi; Yuan, Ting; Wu, Haishan; Zheng, Nigel; Hogan, MaCalus V; Wang, James H-C

2017-12-01

Treatment of tendon-bone junction injuries is a challenge because tendon-bone interface often heals poorly and the fibrocartilage zone, which reduces stress concentration, at the interface is not formed. In this study, we used a compound called kartogenin (KGN) with platelet-rich plasma (PRP) to induce the formation of fibrocartilage zone in a rat tendon graft-bone tunnel model. The experimental rats received KGN-PRP or PRP injections in the tendon graft-bone tunnel interface. The control group received saline. After 4, 8 and 12 weeks, Safranin O staining of the tendon graft-bone tunnels revealed abundant proteoglycans in the KGN-PRP group indicating the formation of cartilage-like transition zone. Immunohistochemical and immuno-fluorescence staining revealed collagen types I (Col-I) and II (Col-II) in the newly formed fibrocartilage zone. Both fibrocartilage zone formation and maturation were healing time dependent. In contrast, the PRP and saline control groups had no cartilage-like tissues and minimal Col-I and Col-II staining. Some gaps were also present in the saline control group. Finally, pull-out strength in the KGN-PRP-treated group at 8 weeks was 1.4-fold higher than the PRP-treated group and 1.6-fold higher than the saline control group. These findings indicate that KGN, with PRP as a carrier, promotes the formation of fibrocartilage zone between the tendon graft and bone interface. Thus, KGN-PRP may be used as a convenient cell-free therapy in clinics to promote fibrocartilage zone formation in rotator calf repair and anterior cruciate ligament reconstruction, thereby enhancing the mechanical strength of the tendon-bone interface and hence the clinical outcome of these procedures. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

THE ROLE OF MECHANOBIOLOGY IN TENDON HEALING

PubMed Central

Killian, Megan L.; Cavinatto, Leonardo; Galatz, Leesa M.; Thomopoulos, Stavros

2011-01-01

Mechanical cues affect tendon healing, homeostasis, and development in a variety of settings. Alterations in the mechanical environment are known to result in changes in the expression of extracellular matrix proteins, growth factors, transcription factors, and cytokines that can alter tendon structure and cell viability. Loss of muscle force in utero or in the immediate postnatal period delays tendon and enthesis development. The response of healing tendons to mechanical load varies depending on anatomic location. Flexor tendons require motion to prevent adhesion formation, yet excessive force results in gap formation and subsequent weakening of the repair. Excessive motion in the setting of anterior cruciate ligament reconstruction causes accumulation of macrophages, which are detrimental to tendon graft healing. Complete removal of load is detrimental to rotator cuff healing, yet large forces are also harmful. Controlled loading can enhance healing in most settings; however, a fine balance must be reached between loads that are too low (leading to a catabolic state) and too high (leading to micro-damage). This review will summarize existing knowledge of the mechanobiology of tendon development, homeostasis, and healing. PMID:22244066

Exposure of a tendon extracellular matrix to synovial fluid triggers endogenous and engrafted cell death: A mechanism for failed healing of intrathecal tendon injuries.

PubMed

Garvican, Elaine R; Salavati, Mazdak; Smith, Roger K W; Dudhia, Jayesh

2017-09-01

The purpose of this study was to investigate the effect of normal synovial fluid (SF) on exposed endogenous tendon-derived cells (TDCs) and engrafted mesenchymal stem cells (MSCs) within the tendon extracellular matrix. Explants from equine superficial digital flexor (extra-synovial) and deep digital flexor tendons (DDFTs) from the compressed, intra-synovial and the tensile, extra-synovial regions were cultured in allogeneic or autologous SF-media. Human hamstring explants were cultured in allogeneic SF. Explant viability was assessed by staining. Proliferation of equine monolayer MSCs and TDCs in SF-media and co-culture with DDFT explants was determined by alamarblue®. Non-viable Native Tendon matrices (NNTs) were re-populated with MSCs or TDCs and cultured in SF-media. Immunohistochemical staining of tendon sections for the apoptotic proteins caspase-3, -8, and -9 was performed. Contact with autologous or allogeneic SF resulted in rapid death of resident tenocytes in equine and human tendon. SF did not affect the viability of equine epitenon cells, or of MSCs and TDCs in the monolayer or indirect explant co-culture. MSCs and TDCs, engrafted into NNTs, died when cultured in SF. Caspase-3, -8, and -9 expression was the greatest in SDFT explants exposed to allogeneic SF. The efficacy of cells administered intra-synovially for tendon lesion repair is likely to be limited, since once incorporated into the matrix, cells become vlnerable to the adverse effects of SF. These observations could account for the poor success rate of intra-synovial tendon healing following damage to the epitenon and contact with SF, common with most soft tissue intra-synovial pathologies.

A Randomised, Placebo-Controlled Trial of Neurodynamic Sliders on Hamstring Responses in Footballers with Hamstring Tightness

PubMed Central

Areeudomwong, Pattanasin; Oatyimprai, Ketsarakon; Pathumb, Saranchana

2016-01-01

Background Neurodynamics intervention is known to increase apparent muscle extensibility, but information regarding hamstring responses after a neurodynamic sliders (NS) technique is scarce. The aim of this study was to evaluate the effects of NS on apparent hamstring extensibility and activity in footballers with hamstring tightness. Methods Forty eligible healthy male footballers with hamstring tightness were each randomly allocated to either a 4-week NS technique or a control group (CG) receiving placebo shortwave intervention. Knee extension angles were measured with the passive knee extension test, and maximal voluntary isometric contraction (MVIC) of hamstrings was measured by a surface electromyography at baseline and after intervention sessions. Results The results showed that NS produced a statistically and clinically significant increase in knee extension angle compared to CG (P < 0.001); however, there was no difference between the groups receiving MVIC of hamstrings. Within group comparison, NS also provided a significant increase in knee extension angle (P < 0.001), whereas the control group did not. There was no change in hamstring MVIC in either group after intervention. Conclusions The findings of this study reveal that four weeks of NS technique improved apparent hamstring extensibility but did not change the hamstring activity in footballers with hamstring tightness. PMID:28090180

Low back pain, radiculopathy, and bilateral proximal hamstring ruptures: a case report.

PubMed

Deren, Matthew E; DeFroda, Steven F; Mukand, Nita H; Mukand, Jon A

2015-12-01

Low back pain (LBP) is a common complaint in the United States, with an incidence of 6.3%-15.4% and yearly recurrence in 54%-90% of patients.1 Trends show more frequent diagnostic testing, opioid use, and surgical intervention as the incidence of LBP increases.2 LBP is defined as pain at and near the lumbosacral region that can vary with physical activity and time. LBP is usually related to pathology of muscles, ligaments, spinal column joints, nerve roots, and the spinal cord. During the assessment of LBP, practitioners must also consider less common causes of pain in that region. For instance, patients with indolent or nighttime pain may have infectious or malignant processes. Referred pain from injuries to pelvic musculature or abdominal contents should be considered, especially following a traumatic event. One of these injuries, which can present as acute low back pain, is rupture of the proximal hamstring tendon. On rare occasion, concomitant LBP, radiculopathy, and hamstring injuries can occur;. This diagnostic challenge is described in the following case.

Should the Ipsilateral Hamstrings Be Used for Anterior Cruciate Ligament Reconstruction in the Case of Medial Collateral Ligament Insufficiency? Biomechanical Investigation Regarding Dynamic Stabilization of the Medial Compartment by the Hamstring Muscles.

PubMed

Herbort, Mirco; Michel, Philipp; Raschke, Michael J; Vogel, Nils; Schulze, Martin; Zoll, Alexander; Fink, Christian; Petersen, Wolf; Domnick, Christoph

2017-03-01

Semitendinosus and gracilis muscles are frequently harvested for autologous tendon grafts for cruciate ligament reconstruction. This study investigated the joint-stabilizing effects of these hamstring muscles in cases of insufficiency of the medial collateral ligament (MCL). First, both the semitendinosus and gracilis muscles can actively stabilize the joint against valgus moments in the MCL-deficient knee. Second, the stabilizing influence of these muscles decreases with an increasing knee flexion angle. Controlled laboratory study. The kinematics was examined in 10 fresh-frozen human cadaveric knees using a robotic/universal force moment sensor system and an optical tracking system. The knee kinematics under 5- and 10-N·m valgus moments were determined in the different flexion angles of the (1) MCL-intact and (2) MCL-deficient knee using the following simulated muscle loads: (1) 0-N (idle) load, (2) 200-N semitendinosus (ST) load, and (3) 280-N (200/80-N) combined semitendinosus/gracilis (STGT) load. Cutting the MCL increased the valgus angle under all tested conditions and angles compared with the MCL-intact knee by 4.3° to 8.1° for the 5-N·m valgus moment and 6.5° to 11.9° for the 10-N·m valgus moment ( P < .01). The applied 200-N simulated ST load reduced the valgus angle significantly at 0°, 10°, 20°, and 30° of flexion under 5- and 10-N·m valgus moments ( P < .05). At 0°, 10°, and 20° of flexion, these values were close to those for the MCL-intact joint under the respective moments (both P > .05). The combined 280-N simulated STGT load significantly reduced the valgus angle in 0°, 10°, and 20° of flexion under 5- and 10-N·m valgus moments ( P < .05) to values near those for the intact joint (5 N·m: 0°, 10°; 10 N·m: 0°, 10°, 20°; P > .05). In 60° and 90° of flexion, ST and STGT loads did not decrease the resulting valgus angle of the MCL-deficient knee without hamstring loads ( P > .05 vs deficient; P = .0001 vs intact). In this

Primary repair of retracted distal biceps tendon ruptures in extreme flexion.

PubMed

Morrey, Mark E; Abdel, Matthew P; Sanchez-Sotelo, Joaquin; Morrey, Bernard F

2014-05-01

Distal biceps tendon ruptures may have tendinous retraction, making primary repair difficult and calling into question the need for graft reconstruction. The decision for when to primarily fix or augment high-flexion repairs has not been addressed. We hypothesized high-flexion repairs would have good outcomes without graft augmentation. The purpose of this study was to examine allograft use and outcomes of distal biceps tendon ruptures requiring repair in greater than 60° of flexion. This was a retrospective case-control study 188 distal biceps tendon repairs; of these, 19 chronic and 4 acute cases were identified with repairs of >60° of flexion using a 2-incision technique. Graft need, complications, and Mayo Elbow Performance Score to assess function, were examined with a record review. Patients were surveyed regarding return to work and subjective satisfaction. A control group matched for surgeon, chronicity, and age, but without a high-flexion repair, was compared with cases by using the Student paired t test. Graft augmentation was used in 1 patient with poor tendon quality. The Mayo Elbow Performance Score was 100 for all 23 patients, with extension/flexion range of motion from 3° to 138°. All were subjectively "very satisfied/satisfied," with full work return, yet 3 reported mild fatigability. There were 4 complications: 3 transient lateral antebrachial cutaneous neurapraxias and 1 rerupture at the myotendinous junction after retrauma. Differences between cases and controls were not statistically significant. Contracted distal biceps tendons may be reliably reattached to their anatomic insertion with up to 90° of elbow flexion. This lessens the need for reconstruction in such circumstances. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Ultrasound-Guided Intratendinous Injections With Platelet-Rich Plasma or Autologous Whole Blood for Treatment of Proximal Hamstring Tendinopathy: A Double-Blind Randomized Controlled Trial.

PubMed

Davenport, Kathleen L; Campos, Jose Santiago; Nguyen, Joseph; Saboeiro, Gregory; Adler, Ronald S; Moley, Peter J

2015-08-01

To compare the effects of ultrasound-guided platelet-rich plasma (PRP) and whole blood (WB) injections in patients with chronic hamstring tendinopathy. In a prospective double-blind randomized controlled trial, PRP or WB was injected under ultrasound guidance into the proximal hamstring tendon in a cohort of patients with clinically suspected hamstring tendinosis. Questionnaires were administered before injection and 2, 6, and 12 weeks and 6 months after injection. Pain and function outcomes were measured via the Modified Harris Hip Score (MHHS), Hip Outcome Scores for activities of daily living (ADL) and sport-specific function, and International Hip Outcome Tool 33 (IHOT-33). Diagnostic ultrasound was used to compare preinjection and 6-month postinjection tendon appearances. The WB group showed greater improvements in pain and function over the PRP group before 12 weeks, whereas the PRP group showed improved outcomes over WB at 6 months. None of these between-group outcome measures, except 6-week IHOT-33, showed statistical significance. Comparing preinjection and 6-month scores, the PRP group showed significant improvements in ADL (P = .018) and IHOT-33 (P = .28) scores, whereas the WB group showed no significant improvements from baseline. The WB group showed significantly decreased pain with 15-minute sitting (P= .008) at 6 months. Ultrasound imaging showed no significant differences between PRP and WB group tendon appearances. Both PRP and WB groups showed improvements in all outcome measures at 6 months. The PRP group showed significant improvements in 6-month ADL and IHOT-33 scores. The WB group reached significance in 15-minute sitting pain. No significant between-group differences were observed at any time point. © 2015 by the American Institute of Ultrasound in Medicine.

Nordic hamstring exercise training alters knee joint kinematics and hamstring activation patterns in young men.

PubMed

Delahunt, Eamonn; McGroarty, Mark; De Vito, Giuseppe; Ditroilo, Massimiliano

2016-04-01

To investigate the kinematic and muscle activation adaptations during performance of the Nordic hamstring exercise (NHE) to a 6-week eccentric hamstring training programme using the NHE as the sole mode of exercise. Twenty-nine healthy males were randomly allocated to a control (CG) or intervention (IG) group. The IG participated in a 6-week eccentric hamstring exercise programme using the NHE. The findings of the present study were that a 6-week eccentric hamstring training programme improved eccentric hamstring muscle strength (202.4 vs. 177.4 nm, p = 0.0002, Cohen's d = 0.97) and optimized kinematic (longer control of the forward fall component of the NHE, 68.1° vs. 73.7°, p = 0.022, Cohen's d = 0.90) and neuromuscular parameters (increased electromyographic activity of the hamstrings, 83.2 vs. 56.6 % and 92.0 vs. 54.2 %, p < 0.05, Cohen's d > 1.25) associated with NHE performance. This study provides some insight into potential mechanisms by which an eccentric hamstring exercise programme utilizing the NHE as the mode of exercise may result in an improvement in hamstring muscle control during eccentric contractions.

Editorial Commentary: Size Does Matter-Anterior Cruciate Ligament Graft Diameter Affects Biomechanical and Clinical Outcomes.

PubMed

Steiner, Mark

2017-05-01

Anterior cruciate ligament (ACL) graft strength is related to graft diameter and how ACL grafts heal. All grafts appear to lose strength during healing. Clinical studies have documented that hamstring grafts less than 8 mm wide are more vulnerable to failure. Tripling the semitendinosus allows to increase the graft diameter and strength. A recent study documents a semitendinosus tripling technique with excellent clinical results. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

The Degree of Knee Extension Does Not Affect Postoperative Stability or Subsequent Graft Tear Rate After Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft.

PubMed

Benner, Rodney W; Shelbourne, K Donald; Gray, Tinker

2016-04-01

There is concern that high degrees of hyperextension may lead to an increase in graft laxity or graft failure after anterior cruciate ligament (ACL) reconstruction. Patients with a high degree of hyperextension will have a higher rate of graft tear/failure and lower subjective scores after surgery compared with patients with less knee extension. Cohort study, Level of evidence, 2. Of 2329 patients who underwent ACL reconstruction with patellar tendon autograft between 1998 and 2008, there were 625 patients who met the inclusion criteria of having primary ACL surgery, no bilateral ACL injuries, no existing osteoarthritis, and having either ≥6° of knee hyperextension before and after surgery (group A: n = 318; mean hyperextension, 8° ± 2° [range, 6°-15°]) or ≤3° of knee hyperextension before and after surgery (group B: n = 307; mean hyperextension, 0° ± 3° [range, 3° hyperextension to -4° short of 0° neutral]). KT-1000 arthrometer manual maximum difference between knees, range of motion measurements, and subjective follow-up with International Knee Documentation Committee (IKDC) and Cincinnati Knee Ratings Scale (CKRS) surveys were used to evaluate results. Subsequent graft tear related to specific injury within 5 years of surgery was recorded. Graft failure was defined as a KT-1000 manual maximum difference of >5 mm. Follow-up was obtained from 278 (87%) in group A and 275 (90%) in group B at a mean of 4.1 ± 1.1 years after surgery. The KT-1000 arthrometer manual maximum difference between knees was 2.0 ± 1.4 in group A and 2.1 ± 1.6 in group B (P = .701). Subsequent ACL graft tear/failure occurred in 22 patients (6.9%) in group A and 30 patients (9.8%) in group B (P = .246). Further subanalysis showed that the graft tear/failure rate was 6 of 81 (7.4%) for patients with ≥10° of hyperextension versus 16 of 237 (6.8%) for patients with 6° to 9° of hyperextension. There was no difference in IKDC or CKRS scores between groups after surgery (P

Distal Attachment of Flexor Tendon Allograft: A Biomechanical Study of Different Reconstruction Techniques in Human Cadaver Hands

PubMed Central

Wei, Zhuang; Thoreson, Andrew R.; Amadio, Peter C.; An, Kai-Nan; Zhao, Chunfeng

2014-01-01

We compared the mechanical force of tendon-to-bone repair techniques for flexor tendon reconstruction. Thirty-six flexor digitorum profundus (FDP) tendons were divided into three groups based upon the repair technique: (1) suture/button repair using FDP tendon (Pullout button group), (2) suture bony anchor using FDP tendon (Suture anchor group), and (3) suture/button repair using FDP tendon with its bony attachment preserved (Bony attachment group). The repair failure force and stiffness were measured. The mean load to failure and stiffness in the bony attachment group were significantly higher than that in the pullout button and suture anchor groups. No significant difference was found in failure force and stiffness between the pullout button and suture anchor groups. An intrasynovial flexor tendon graft with its bony attachment has significantly improved tensile properties at the distal repair site when compared with a typical tendon-to-bone attachment with a button or suture anchor. The improvement in the tensile properties at the repair site may facilitate postoperative rehabilitation and reduce the risk of graft rupture. PMID:23754507

A Reconstructive Stabilization Technique for Nontraumatic or Chronic Traumatic Extensor Tendon Subluxation.

PubMed

Lee, Jae Hoon; Baek, Jong Hun; Lee, Jung Seok

2017-01-01

Subluxation of the extensor tendon results from a disruption to the sagittal band at the metacarpophalangeal joint. When conservative treatment fails to correct the subluxation, surgical treatment may be necessary. Surgical techniques for chronic cases vary in graft source and graft pathway. We present a surgical technique to recentralize and stabilize the extensor tendon using a residual ruptured sagittal band. This technique is simple and effective without donor site morbidity and seems to provide potential biomechanical advantages by restoring nearly normal anatomy. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Patellar tendon healing with platelet-rich plasma: a prospective randomized controlled trial.

PubMed

de Almeida, Adriano Marques; Demange, Marco Kawamura; Sobrado, Marcel Faraco; Rodrigues, Marcelo Bordalo; Pedrinelli, André; Hernandez, Arnaldo José

2012-06-01

The patellar tendon has limited ability to heal after harvesting its central third. Platelet-rich plasma (PRP) could improve patellar tendon healing. Adding PRP to the patellar tendon harvest site would improve donor site healing and improve clinical outcome at 6 months after anterior cruciate ligament (ACL) reconstruction with a patellar tendon graft. Randomized controlled trial; Level of evidence, 1. Twenty-seven patients were randomly divided to receive (n = 12) or not receive (n = 15) PRP in the patellar tendon harvest site during ACL reconstruction. The primary outcome was magnetic resonance imaging (MRI) assessment of patellar tendon healing (gap area) after 6 months. Secondary outcomes were questionnaires and isokinetic testing of ACL reconstruction with a patellar tendon graft comparing both groups. Patellar tendon gap area was significantly smaller in the PRP group (4.9 ± 5.3 mm(2); 95% confidence interval [CI], 1.1-8.8) than in the control group (9.4 ± 4.4 mm(2); 95% CI, 6.6-12.2; P = .046). Visual analog scale score for pain was lower in the PRP group immediately postoperatively (3.8 ± 1.0; 95% CI, 3.18-4.49) than in the control group (5.1 ± 1.4; 95% CI, 4.24-5.90; P = .02). There were no differences after 6 months in questionnaire and isokinetic testing results comparing both groups. We showed that PRP had a positive effect on patellar tendon harvest site healing on MRI after 6 months and also reduced pain in the immediate postoperative period. Questionnaire and isokinetic testing results were not different between the groups at 6 months.

Proximal Hamstring Tendinosis and Partial Ruptures.

PubMed

Startzman, Ashley N; Fowler, Oliver; Carreira, Dominic

2017-07-01

Proximal hamstring tendinosis and partial hamstring origin ruptures are painful conditions of the proximal thigh and hip that may occur in the acute, chronic, or acute on chronic setting. Few publications exist related to their diagnosis and management. This systematic review discusses the incidence, treatment, and prognosis of proximal hamstring tendinosis and partial hamstring ruptures. Conservative treatment measures include nonsteroidal anti-inflammatory drugs, physical therapy, rest, and ice. If these measures fail, platelet-rich plasma or shockwave therapy may be considered. When refractory to conservative management, these injuries may be treated with surgical debridement and hamstring reattachment. [Orthopedics. 2017; 40(4):e574-e582.]. Copyright 2017, SLACK Incorporated.

Anatomy of the Adductor Magnus Origin

PubMed Central

Obey, Mitchel R.; Broski, Stephen M.; Spinner, Robert J.; Collins, Mark S.; Krych, Aaron J.

2016-01-01

Background: The adductor magnus (AM) has historically been a potential source of confusion in patients with suspected proximal hamstring avulsion injuries. Purpose: To investigate the anatomic characteristics of the AM, including its osseous origin, anatomic dimensions, and relationship to the proximal hamstring tendons. Study Design: Descriptive laboratory study. Methods: Dissection of the AM origin was performed in 11 (8 cadavers) fresh-frozen hip-to-foot cadaveric hemipelvis specimens. The gross anatomy and architecture of the proximal hamstring and AM tendons were studied. After dissecting the hamstring tendons away from their origin, the dimension, shape, and orientation of the tendon footprints on the ischial tuberosity were determined. Results: The AM was identified in all cadaveric specimens. The mean tendon thickness (anterior to posterior [AP]) was 5.7 ± 2.9 mm. The mean tendon width (medial to lateral [ML]) was 7.1 ± 2.2 mm. The mean tendon length was 13.1 ± 8.7 cm. The mean footprint height (AP dimension) was 12.1 ± 2.9 mm, and mean footprint width (ML dimension) was 17.3 ± 7.1 mm. The mean distance between the AM footprint and the most medial aspect of the conjoint tendon footprint was 8.5 ± 4.2 mm. Tendon measurements demonstrated a considerable degree of both intra- and interspecimen variability. Conclusion: The AM tendon is consistently present just medial to the conjoint tendon at the ischial tuberosity, representing the lateral-most portion of the AM muscle. This study found wide variation in the dimensional characteristics of the AM tendon between specimens. Its shape and location can mimic the appearance of an intact hamstring (conjoint or semimembranosus) tendon intraoperatively or on diagnostic imaging, potentially misleading surgeons and radiologists. Therefore, detailed knowledge of the AM tendon anatomy, footprint anatomy, and its relationship to the hamstring muscle complex is paramount when planning surgical approach and technique

Septic Arthritis After Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes Based on Graft Retention or Removal.

PubMed

Waterman, Brian R; Arroyo, William; Cotter, Eric J; Zacchilli, Michael A; Garcia, E'Stephan J; Owens, Brett D

2018-03-01

There remains a debate over whether to retain the index anterior cruciate ligament (ACL) graft in the setting of septic arthritis. To evaluate and compare clinical outcomes for the treatment of septic arthritis after ACL reconstruction (ACLR) in those with and without early graft retention. Case series; Level of evidence, 4. The Military Health System was queried for all ACLR procedures performed between 2007 and 2013. Inclusion criteria required active military status, primary ACLR with secondary septic arthritis, and minimum 24-month surveillance. Demographic, clinical, and surgical variables were evaluated using descriptive statistics and regression analysis for factors influencing selected outcomes. Of 9511 ACLR procedures, 31 (0.32%) were identified as having secondary septic arthritis requiring urgent arthroscopic irrigation and debridement and intravenous antibiotics (mean, 6.3 weeks). The majority (62%) were treated in the subacute (2 weeks to 2 months) setting. Index ACLR was performed with a hamstring autograft (n = 17, 55%), soft tissue allograft (n = 11, 35%), and patellar tendon autograft (n = 3, 10%). The graft was retained in 71% (n = 22) of patients, while 29% (n = 9) underwent early graft debridement. At a mean 26.9-month follow-up, 48% of patients (n = 15) had returned to the military. Graft removal was not predictive of return to active duty ( P = .29). The presence of postoperative complications, including symptomatic postinfection arthritis (22.6%) and arthrofibrosis (9.7%), was the only variable predictive of inability to return to duty (odds ratio, 27.5 [95% CI, 3.24-233.47]; P = .002). Seven of 9 patients who underwent graft debridement underwent revision ACLR, and all 7 had stable knees at final follow-up compared with 68% (15/22) in the graft retention group. Arthroscopic debridement with early graft removal and staged revision ACLR remains a viable option for restoring knee stability (100%), although the rate of return to active duty was

Septic Arthritis After Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes Based on Graft Retention or Removal

PubMed Central

Waterman, Brian R.; Arroyo, William; Cotter, Eric J.; Zacchilli, Michael A.; Garcia, E’Stephan J.; Owens, Brett D.

2018-01-01

Background: There remains a debate over whether to retain the index anterior cruciate ligament (ACL) graft in the setting of septic arthritis. Purpose: To evaluate and compare clinical outcomes for the treatment of septic arthritis after ACL reconstruction (ACLR) in those with and without early graft retention. Study Design: Case series; Level of evidence, 4. Methods: The Military Health System was queried for all ACLR procedures performed between 2007 and 2013. Inclusion criteria required active military status, primary ACLR with secondary septic arthritis, and minimum 24-month surveillance. Demographic, clinical, and surgical variables were evaluated using descriptive statistics and regression analysis for factors influencing selected outcomes. Results: Of 9511 ACLR procedures, 31 (0.32%) were identified as having secondary septic arthritis requiring urgent arthroscopic irrigation and debridement and intravenous antibiotics (mean, 6.3 weeks). The majority (62%) were treated in the subacute (2 weeks to 2 months) setting. Index ACLR was performed with a hamstring autograft (n = 17, 55%), soft tissue allograft (n = 11, 35%), and patellar tendon autograft (n = 3, 10%). The graft was retained in 71% (n = 22) of patients, while 29% (n = 9) underwent early graft debridement. At a mean 26.9-month follow-up, 48% of patients (n = 15) had returned to the military. Graft removal was not predictive of return to active duty (P = .29). The presence of postoperative complications, including symptomatic postinfection arthritis (22.6%) and arthrofibrosis (9.7%), was the only variable predictive of inability to return to duty (odds ratio, 27.5 [95% CI, 3.24-233.47]; P = .002). Seven of 9 patients who underwent graft debridement underwent revision ACLR, and all 7 had stable knees at final follow-up compared with 68% (15/22) in the graft retention group. Conclusion: Arthroscopic debridement with early graft removal and staged revision ACLR remains a viable option for restoring knee

Patellar Sleeve Fracture With Ossification of the Patellar Tendon.

PubMed

Damrow, Derek S; Van Valin, Scott E

2017-03-01

Patellar sleeve fractures make up greater than 50% of all patellar fractures. They are essentially only seen in the pediatric population because of the thick periosteum and the distal patellar pole apophysis in this group. These fractures can lead to complications if not treated appropriately and in a timely fashion. Complications of missed or untreated patellar sleeve fractures include patella alta, anterior knee pain, and quadriceps atrophy. These can all result in severe limitations in activity. The authors describe a case of a 16-year-old boy who sustained a patellar sleeve fracture 3 years prior to presentation. On presentation, he had patella alta, diminished strength, 5° of extensor lag, and radiographs that revealed bone formation along the patellar tendon. Despite this, he was able to maintain a high level of activity. This case report explores how the patient could have maintained a high level of activity despite having a patellar sleeve fracture. Also, because of the delayed presentation, the patella was ossified and the quadriceps was retracted, which led to a novel approach to reconstructing his distal extensor mechanism. This approach included a V-Y advancement of the quadriceps tendon and patellar tendon reconstruction using the patient's hamstring tendon (semitendinosus). This technique, combined with physical therapy postoperatively, resulted in his return to varsity high school soccer. To the best of the authors' knowledge, this technique has not been reported for this rare condition. [Orthopedics. 2017; 40(2):e357-e359.]. Copyright 2016, SLACK Incorporated.

Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations.

PubMed

Choi, Nam Hong; Lim, Seok Min; Lee, Sang Young; Lim, Tae Kang

2017-04-01

This study was conducted to report loss of reduction and complications after single-tunnel coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus tendon graft for acute acromioclavicular (AC) joint dislocations. This retrospective study included patients with acute, unstable AC dislocations (surgery within 6 weeks after trauma). We excluded patients with chronic injury and distal clavicle fractures with CC ligaments disruption. We measured the CC distance on anteroposterior radiographs of both clavicles, preoperatively, immediately postoperatively, and at the final follow-up visit. We evaluated clinical outcomes using the American Shoulder and Elbow Surgeons Shoulder Assessment and the University of California, Los Angeles Shoulder Rating Scale scores and perioperative complications. There were 30 patients (27 men and 3 women) with mean age of 41 years (range, 19-70 years). The mean follow-up period was 31 months (range, 12-186 months). Mean CC distance was 15.5 ± 3.7 mm (84% ± 14% of the contralateral shoulder) preoperatively, 8.9 ± 2.6 mm (9% ± 40%) immediately postoperatively (P < .001), and 10.6 ± 3.3 mm (24% ± 39%) at the final assessment (P < .001), showing an increase of the CC distance during the follow-up. Loss of reduction (defined as >25% increase of CC distance) developed in 14 patients (47%), and complications occurred in 6 patients (20%), including 3 distal clavicle fractures through the tunnel. Final clinical scores were significantly lower in patients with complications (27 vs. 33 of the University of California, Los Angeles assessment [P < .001] and 81 vs. 95 of the American Shoulder and Elbow Surgeons Shoulder assessment [P < .001]). In acute AC joint dislocation, single-tunnel CC ligament reconstruction using autogenous tendon graft resulted in loss of reduction rate of 47% and a complication rate of 20%. The development of complications adversely affected clinical outcomes

Conservative Treatment of Subacute Proximal Hamstring Tendinopathy Using Eccentric Exercises Performed With a Treadmill: A Case Report.

PubMed

Cushman, Daniel; Rho, Monica E

2015-07-01

Case report. Proximal hamstring tendinopathy in runners is characterized by pain with passive hip flexion with the knee extended, active hip extension, and pain with sitting. Relatively little literature exists on the condition, and publications on nonsurgical treatment protocols are even more scarce. Surgical intervention, which comprises the majority of literature for treatment of this condition, is an option for cases that fail to respond to nonsurgical treatment. The patient was a 34-year-old, otherwise healthy male triathlete with unilateral proximal hamstring tendinopathy diagnosed by ultrasound, who had pain only with running and prolonged sitting. After he failed to respond to 4 weeks of eccentric knee flexion and lumbopelvic musculature strengthening exercises, an eccentric hip extensor strengthening program using a treadmill was initiated. This treadmill exercise was performed on a daily basis, in addition to a lumbopelvic musculature strengthening program. The patient noted a decrease in pain within 2 weeks of initiating the new exercise, and was able to return to gradual running after 4 weeks and to speed training after 12 weeks. He returned to competition shortly thereafter and had no recurrence for 12 months after the initiation of therapy. His score on the Victorian Institute of Sport Assessment-proximal hamstring tendons improved from 23 on initial presentation to 83 at 12 weeks after the initiation of therapy. We described the management of a triathlete with subacute proximal hamstring tendinopathy, who responded well to nonsurgical treatment using eccentric hip extension strengthening using a treadmill. Therapy, level 4.

Conservative Treatment of Subacute Proximal Hamstring Tendinopathy Using Eccentric Exercises Performed With a Treadmill: A Case Report

PubMed Central

CUSHMAN, DANIEL; RHO, MONICA E.

2015-01-01

STUDY DESIGN Case report. BACKGROUND Proximal hamstring tendinopathy in runners is characterized by pain with passive hip flexion with the knee extended, active hip extension, and pain with sitting. Relatively little literature exists on the condition, and publications on nonsurgical treatment protocols are even more scarce. Surgical intervention, which comprises the majority of literature for treatment of this condition, is an option for cases that fail to respond to nonsurgical treatment. CASE DESCRIPTION The patient was a 34-year-old, otherwise healthy male triathlete with unilateral proximal hamstring tendinopathy diagnosed by ultrasound, who had pain only with running and prolonged sitting. After he failed to respond to 4 weeks of eccentric knee flexion and lumbopelvic musculature strengthening exercises, an eccentric hip extensor strengthening program using a treadmill was initiated. This treadmill exercise was performed on a daily basis, in addition to a lumbopelvic musculature strengthening program. OUTCOMES The patient noted a decrease in pain within 2 weeks of initiating the new exercise, and was able to return to gradual running after 4 weeks and to speed training after 12 weeks. He returned to competition shortly thereafter and had no recurrence for 12 months after the initiation of therapy. His score on the Victorian Institute of Sport Assessment-proximal hamstring tendons improved from 23 on initial presentation to 83 at 12 weeks after the initiation of therapy. DISCUSSION We described the management of a triathlete with subacute proximal hamstring tendinopathy, who responded well to nonsurgical treatment using eccentric hip extension strengthening using a treadmill. LEVEL OF EVIDENCE Therapy, level 4. PMID:25996362

An Overview of the Management of Flexor Tendon Injuries

PubMed Central

Griffin, M; Hindocha, S; Jordan, D; Saleh, M; Khan, W

2012-01-01

Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. Since the first flexor tendon repair was described by Kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 70-90%. Primary surgical repair results in better functional outcome compared to secondary repair or tendon graft surgery. Flexor tendon injury repair has been extensively researched and the literature demonstrates successful repair requires minimal gapping at the repair site or interference with tendon vascularity, secure suture knots, smooth junction of tendon end and having sufficient strength for healing. However, the exact surgical approach to achieve success being currently used among surgeons is still controversial. Therefore, this review aims to discuss the results of studies demonstrating the current knowledge regarding the optimal approach for flexor tendon repair. Post-operative rehabilitation for flexor tendon surgery is another area, which has caused extensive debate in hand surgery. The trend to more active mobilisation protocols seems to be favoured but further study in this area is needed to find the protocol, which achieves function and gliding but avoids rupture of the tendons. Lastly despite success following surgery complications commonly still occur post surgery, including adhesion formation, tendon rupture and stiffness of the joints. Therefore, this review aims to discuss the appropriate management of these difficulties post surgery. New techniques in management of flexor tendon will also be discussed including external laser devices, addition of growth factors and cytokines. PMID:22431948

Heterotopic mineralization (ossification or calcification) in tendinopathy or following surgical tendon trauma

PubMed Central

O'Brien, Etienne J O; Frank, Cyril B; Shrive, Nigel G; Hallgrímsson, Benedikt; Hart, David A

2012-01-01

Heterotopic tendon mineralization (ossification or calcification), which may be a feature of tendinopathy or which may develop following surgical trauma (repair or graft harvest), has not received much attention. The purpose of this article is to review the prevalence, mechanisms and consequences of heterotopic tendon mineralization and to identify the gaps in our current understanding. We focus on endochondral heterotopic ossification and draw on knowledge of the mechanisms of this process in other tissues and conditions. Finally, we introduce a novel murine Achilles tendon needle injury model, which will enable us to further study the mechanisms and biomechanical consequences of tendon mineralization. PMID:22974213

Semitendinosus Tendon Autograft for Reconstruction of Large Defects in Chronic Achilles Tendon Ruptures.

PubMed

Dumbre Patil, Sampat Shivajirao; Dumbre Patil, Vaishali Sampat; Basa, Vikas Rajeshwarrao; Dombale, Ajay Birappa

2014-07-01

Chronic Achilles tendon ruptures are associated with considerable functional morbidity. When treated operatively, debridement of degenerated tendon ends may create large defects. Various procedures to reconstruct large defects have been described. We present a simple technique in which an autologous semitendinosus tendon graft is used to reconstruct defects larger than 5 cm in chronic Achilles tendon ruptures. The purpose of this study was to describe our operative technique and its functional outcome. Achilles ruptures of more than 6 weeks duration were considered for the study. We treated 35 patients (20 males, 15 females) with symptomatic chronic Achilles tendon ruptures. The mean age was 47.4 years (range, 30 to 59). The smallest defect that we had reconstructed was 5 cm, and the largest was 9 cm in length. The average follow-up duration was 30.7 months (range, 20 to 42). Postoperatively, the strength of gastrocsoleus was measured by manual muscle testing (MMT) in non-weight-bearing and weight-bearing positions. All operated patients showed satisfactory functional outcome, good soft tissue healing, and no reruptures. The preoperative weight-bearing MMT of 2/5 improved to 4/5 or 5/5 postoperatively. In all patients, postoperative non-weight-bearing MMT was 5/5. All patients returned to their prerupture daily activity. We present a technique that is simple, with low morbidity. We believe it is a valuable option especially when allografts are not available. It is inexpensive as suture anchors or tenodesis screws are not used. This can be a useful option if other tendons (flexor hallucis longus, peroneus brevis, etc) are not available for transfer. Level IV, retrospective case series. © The Author(s) 2014.

Cell-laden composite suture threads for repairing damaged tendons.

PubMed

Costa-Almeida, Raquel; Domingues, Rui M A; Fallahi, Afsoon; Avci, Huseyin; Yazdi, Iman K; Akbari, Mohsen; Reis, Rui L; Tamayol, Ali; Gomes, Manuela E; Khademhosseini, Ali

2018-04-01

Tendons have limited regenerative capacity due to their low cellularity and hypovascular nature, which results in poor clinical outcomes of presently used therapies. As tendon injuries are often observed in active adults, it poses an increasing socio-economic burden on healthcare systems. Currently, suture threads are used during surgical repair to anchor the tissue graft or to connect injured ends. Here, we created composite suture threads coated with a layer of cell-laden hydrogel that can be used for bridging the injured tissue aiming at tendon regeneration. In addition, the fibres can be used to engineer 3-dimensional constructs through textile processes mimicking the architecture and mechanical properties of soft tissues, including tendons and ligaments. Encapsulated human tendon-derived cells migrated within the hydrogel and aligned at the surface of the core thread. An up-regulation of tendon-related genes (scleraxis and tenascin C) and genes involved in matrix remodelling (matrix metalloproteinases 1, matrix metalloproteinases 2) was observed. Cells were able to produce a collagen-rich matrix, remodelling their micro-environment, which is structurally comparable to native tendon tissue. Copyright © 2017 John Wiley & Sons, Ltd.

Development and validation of a new visa questionnaire (VISA-H) for patients with proximal hamstring tendinopathy.

PubMed

Cacchio, Angelo; De Paulis, Fosco; Maffulli, Nicola

2014-03-01

There is a need for a patient-reported outcome (PRO) questionnaire to evaluate patients with proximal hamstring tendinopathy (PHT). To develop a PRO questionnaire based on VISA questionnaire forms for patients with PHT. Item generation, item reduction, item scaling and evaluation of the psychometric properties were used to develop a questionnaire to assess the severity of symptoms, function and ability to play sports in patients with PHT and healthy subjects. The final version, named Victorian Institute of Sport Assessment-Proximal Hamstring Tendons (VISA-H), consisted of eight questions that measured the domains of pain, function and sporting activity. The psychometric properties of a questionnaire were estimated in a population of non-surgical (n=20) and surgical (n=10) patients, as well as in healthy subjects (n=30). The VISA-H questionnaire displayed a high degree of internal consistency, with a Cronbach α of 0.84. (The test-retest reliability was high for all groups of participants with an intraclass correlation coefficient ranging from 0.90 to 0.95.) The VISA-H exhibited a high correlation with the Nirschl phase rating scale (r ranging from -0.75 to -0.89) and a generic tendon grading system proposed by Curwin and Stanish (r ranging from -0.70 to -0.88). Also, the responsiveness was higher for the VISA-H questionnaire with an area under the curve of 0.90 and a minimum clinically important difference of 22 points. The VISA-H is a PRO questionnaire with high psychometric properties for measuring pain, function and sporting activity in patients with PHT.

Hamstring Stiffness Returns More Rapidly After Static Stretching Than Range of Motion, Stretch Tolerance, and Isometric Peak Torque.

PubMed

Hatano, Genki; Suzuki, Shigeyuki; Matsuo, Shingo; Kataura, Satoshi; Yokoi, Kazuaki; Fukaya, Taizan; Fujiwara, Mitsuhiro; Asai, Yuji; Iwata, Masahiro

2017-12-18

Hamstring injuries are common, and lack of hamstring flexibility may predispose to injury. Static stretching increases range of motion (ROM) but also results in reduced muscle strength after stretching. The effects of stretching on the hamstring muscles and the duration of these effects remain unclear. To determine the effects of static stretching on the hamstrings and the duration of these effects. Randomized crossover study. University laboratory. Twenty-four healthy volunteers. We measured the torque-angle relationship (ROM, passive torque (PT) at the onset of pain, and passive stiffness) and isometric muscle force using an isokinetic dynamometer. After a 60-minute rest, the ROM of the dynamometer was set at maximum tolerable intensity; this position was maintained for 300 seconds while static passive torque (SPT) was measured continuously. We remeasured the torque-angle relationship and isometric muscle force after rest periods of 10, 20, and 30 minutes. Change in SPT during stretching; changes in ROM, PT at the onset of pain, passive stiffness, and isometric muscle force before stretching compared with 10, 20, and 30 minutes after stretching. SPT decreased significantly during stretching. Passive stiffness decreased significantly 10 and 20 minutes after stretching, but there was no significant pre- vs. post-stretching difference after 30 minutes. PT at the onset of pain and ROM increased significantly after stretching at all rest intervals, while isometric muscle force decreased significantly after all rest intervals. The effect of static stretching on passive stiffness of the hamstrings was not maintained as long as the changes in ROM, stretch tolerance, and isometric muscle force. Therefore, frequent stretching is necessary to improve the viscoelasticity of the muscle-tendon unit. Muscle force was decreased for 30 minutes after stretching; this should be considered prior to activities requiring maximal muscle strength.

Incidence of bacterial contamination and predisposing factors during bone and tendon allograft procurement.

PubMed

Terzaghi, Clara; Longo, Alessia; Legnani, Claudio; Bernasconi, Davide Paolo; Faré, Maristella

2015-03-01

The aim of this study was to analyze factors contributing to bacteriological contamination of bone and tendon allograft. Between 2008 and 2011, 2,778 bone and tendon allografts obtained from 196 organ and tissue donors or tissue donors only were retrospectively analysed. Several variables were taken into account: donor type (organ and tissue donors vs. tissue donor), cause of death, time interval between death and tissue procurement, duration of the procurement procedure, type of allografts, number of team members, number of trainees members, associated surgical procedures, positivity to haemoculture, type of procurement. The overall incidence of graft contamination was 23 %. The cause of death, the procurement time, the duration of procurement, the associated surgical procedures were not associated with increased risk of contamination. Significant effect on contamination incidence was observed for the number of staff members performing the procurement. In addition, our study substantiated significantly higher contamination rate among bone allografts than from tendon grafts. According to these observations, in order to minimize the contamination rate of procured musculoskeletal allografts, we recommend appropriate donor selection, use of standard sterile techniques, immediate packaging of each allograft to reduce graft exposure. Allograft procurement should be performed by a small surgical team.

Immediate Effects of Neurodynamic Sliding versus Muscle Stretching on Hamstring Flexibility in Subjects with Short Hamstring Syndrome

PubMed Central

Castellote-Caballero, Yolanda; Valenza, Maríe C.; Puentedura, Emilio J.; Fernández-de-las-Peñas, César; Alburquerque-Sendín, Francisco

2014-01-01

Background. Hamstring injuries continue to affect active individuals and although inadequate muscle extensibility remains a commonly accepted factor, little is known about the most effective method to improve flexibility. Purpose. To determine if an isolated neurodynamic sciatic sliding technique would improve hamstring flexibility to a greater degree than stretching or a placebo intervention in asymptomatic subjects with short hamstring syndrome (SHS). Study Design. Randomized double-blinded controlled trial. Methods. One hundred and twenty subjects with SHS were randomized to 1 of 3 groups: neurodynamic sliding, hamstring stretching, and placebo control. Each subject's dominant leg was measured for straight leg raise (SLR) range of motion (ROM) before and after interventions. Data were analyzed with a 3 × 2 mixed model ANOVA followed by simple main effects analyses. Results. At the end of the study, more ROM was observed in the Neurodynamic and Stretching groups compared to the Control group and more ROM in the Neurodynamic group compared to Stretching group. Conclusion. Findings suggest that a neurodynamic sliding technique will increase hamstring flexibility to a greater degree than static hamstring stretching in healthy subjects with SHS. Clinical Relevance. The use of neurodynamic sliding techniques to improve hamstring flexibility in sports may lead to a decreased incidence in injuries; however, this needs to be formally tested. PMID:26464889

The single-leg Roman chair hold is more effective than the Nordic hamstring curl in improving hamstring strength-endurance in Gaelic footballers with previous hamstring injury.

PubMed

Macdonald, Ben; O'Neill, John; Pollock, Noel; Van Hooren, Bas

2018-03-06

Poor hamstring strength-endurance is a risk factor for hamstring injuries. This study investigated the effectiveness of the single-leg Roman hold and Nordic hamstring curl in improving hamstring strength-endurance. Twelve Gaelic footballers (mean ± standard deviation age, height and mass were 25.17 ± 3.46 years, 179.25 ± 5.88 cm, 85.75 ± 4.75 kilo) with a history of hamstring injury were randomized into 2 groups that performed 6 weeks of either Nordic hamstring curl, or single-leg Roman chair hold training. The single-leg hamstring bridge (SLHB) was measured pre- and post- intervention. The Roman chair group showed a very likely moderate magnitude improvement on SLHB performance for both legs (23.7% for the previously injured leg [90% confidence interval 9.6% to 39.6%] and 16.9% for the non-injured leg [6.2% to 28.8%]). The Nordic curl group showed a likely trivial change in SLHB performance for the non-injured leg (-2.1% [-6.7% to 2.6%]) and an unclear, but possibly trivial change for the previously injured leg (0.3% [-5.6% to 6.6%]). The Roman chair group improved very likely more with a moderate magnitude in both the non-injured (19.5% [8.0% to 32.2%]) and the previously injured leg (23.3% [8.5% to 40.0%]) compared to the Nordic curl group. This study demonstrated that 6-weeks single-leg Roman chair training substantially improved SLHB performance, suggesting that it may be an efficacious strategy to mitigate hamstring (re-) injury risk. Conversely, 6-weeks Nordic curl training did not substantially improve SLHB performance, suggesting this may not be the intervention of choice for modifying this risk factor.

Tendon healing in a bone tunnel. Part II: Histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep.

PubMed

Weiler, Andreas; Hoffmann, Reinhard F G; Bail, Hermann J; Rehm, Oliver; Südkamp, Norbert P

2002-02-01

Tendon-to-bone healing of soft-tissue grafts has been described to progress by the development of a fibrous interzone that undergoes a maturation process leading to the development of an indirect type of ligament insertion. Previous studies used extra-articular models or fixation far away from the joint line; thus, no data are available investigating tendon-to-bone healing of a soft-tissue graft fixed anatomically. Therefore, we studied the tendon-to-bone healing of the anatomic soft-tissue graft interference fit fixation in a model of anterior cruciate ligament (ACL) reconstruction in sheep. Animal study. Thirty-five mature sheep underwent ACL reconstruction with an autologous Achilles tendon split graft. Grafts were directly fixed with biodegradable poly-(D,L-lactide) interference screws. Animals were euthanized after 6, 9, 12, 24, and 52 weeks and histologic evaluations were performed. Undecalcified specimens were evaluated under normal and polarized light. Additionally, animals received a polychrome sequential labeling (tetracycline, xylenol orange, and calcein green) to determine bone growth per time under fluorescent light. Intratunnel histologic findings at 6 weeks showed a tendon-bone junction with only a partial fibrous interzone between the graft tissue and the surrounding bone. A mature intratunnel tendon-bone junction with a zone of fibrocartilage was found at 9 to 12 weeks. At the tunnel entrance site a wide regular ligamentous insertion site was seen in all specimens after 24 weeks. This insertion showed regular patterns such as the direct type of insertion of a normal ligament with a dense basophilic transition zone consisting of mineralized cartilage. A fibrous interzone between the graft tissue and the bone tunnel was only partially developed, which is in contrast to all previous studies in which nonanatomic fixation was used. Thus, it is reasonable to assume that the tendon-to-bone healing in the present study may progress partially by direct

Kinetic and kinematic evaluation of the ankle joint after achilles tendon reconstruction with free semitendinosus tendon graft: preliminary results.

PubMed

Lins, Carolina; Ninomya, André Felipe; Bittar, Cintia Kelly; de Carvalho, Antônio Egydio; Cliquet, Alberto

2013-03-01

Chronic rupture of the Achilles tendon (AT) is a surgical challenge and has effects on the gait. The purpose of this study was to evaluate the kinetic and kinematic parameters of the ankle joint in patients with AT rupture operated using a free semitendinosus tendon graft. Thirteen patients were analyzed 6 and 12 months after surgery in a force platform, while the movements were recorded by six infrared cameras. The kinematic variables analyzed included speed, cadence, step length, percentage of stance phase, and range of movement (ROM) of the ankle joint in the sagittal and frontal planes. Kinetic data were obtained by joint movement in different phases of the gait cycle. Functional assessment was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score. The patients showed a significant increase (P = 0.0215) in AOFAS from 68.5 (±18.7) to 85.2 (±18.0). Speed, cadence, and length of step of the four groups (1A, 1B, 2A, 2B) were lower than the control group (group 3), and the percentage in stance phase was higher for the nonoperated foot 6-month group (1B) compared to the control group (group 3). For the kinematic data, the ROM of the ankle in stance phase increased from 6 to 12 months showing an effect of time between four groups (1A, 1B, 2A, 2B). During swing phase, the ankle ROM was lower in the operated side (effect of side, P = 0.0255) and groups 1A and 2A demonstrated statistical differences when compared with the control group (group 3) (P = 0.0240 and P = 0.0414, respectively). ROM of inversion and eversion presented effect of time among the same groups (P = 0.0059) cited before. There were no differences in kinetic data between groups. This study showed close proximity between the control group and the operated group. Furthermore, improvement was shown when comparing the 6 and 12 months postsurgery periods. The surgical procedure is therefore helpful for the patient and few changes were present in gait and ankle

Soft tissue stabilization for palmar midcarpal instability using a palmaris longus tendon graft.

PubMed

Chaudhry, Tahseen; Shahid, Mohammed; Wu, Feiran; Mishra, Anuj; Deshmukh, Subodh

2015-01-01

To report the results of a technique of soft tissue stabilization for palmar midcarpal instability using a palmaris longus graft. In patients' symptomatic wrists with palmar midcarpal instability that had failed conservative management, we used a dorsal approach and stabilized the hamate and triquetrum by reconstructing the dorsal triquetrohamate ligament. The palmaris longus tendon graft was fixed with bone anchors. Seven wrists in 6 patients were available for follow-up at a mean of 28 months (range, 17-37 mo). There was an overall meaningful improvement in function (mean preoperative Disabilities of the Arm, Shoulder, and Hand score, 49 preoperatively, 28 postoperatively). There was a significant increase in grip strength from 15 to 21 kg. At final follow-up, 2 patients had moderate pain. The others had mild or no pain. Four patients returned to their previous occupation or activity. Patients retained full pronation and supination. When compared with the normal side, flexion was reduced to 71%, extension to 81%, radial deviation to 90%, and ulnar deviation to 65% of the opposite side. Although the mean results show an improvement, one patient had a poor result with deterioration in Disabilities of the Arm, Shoulder, and Hand score in spite of a clinically stable wrist, and another had clinical evidence of recurrent instability during pregnancy. One patient had residual symptoms from a prominent bone anchor. Overall, this technique showed good medium-term results in most of our patients. It retained some midcarpal mobility, eliminated clunking in most patients, and provided a noteworthy improvement in grip strength and function. We continue to use this technique for patients with symptomatic midcarpal instability, but it requires further evaluation with larger patient numbers and a longer follow-up to assess its overall value. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport.

PubMed

Askling, Carl M; Tengvar, Magnus; Saartok, Tönu; Thorstensson, Alf

2008-09-01

Hamstring strains can be of at least 2 types, 1 occurring during high-speed running and the other during motions in which the hamstring muscles reach extreme lengths, as documented for sprinters and dancers. Hamstring strains in different sports, with similar injury situations to dancers, also show similarities in symptoms, injury location, and recovery time. Case series (prognosis); Level of evidence, 4. Thirty subjects from 21 different sports were prospectively included. All subjects were examined clinically and with magnetic resonance imaging (MRI). The follow-up period lasted until the subjects returned to or finished their sport activity. All injuries occurred during movements reaching a position with combined extensive hip flexion and knee extension. They were located proximally in the posterior thigh, close to the ischial tuberosity. The injuries were often complex, but 83% involved the semimembranosus and its proximal free tendon. Fourteen subjects (47%) decided to end their sports activity. For the remaining 16 subjects, the median time for return to sport was 31 weeks (range, 9-104). There were no significant correlations between specific clinical or MRI parameters and time to return to sport. In different sports, an injury situation in which the hamstring muscles reach extensive length causes a specific injury to the proximal posterior thigh, earlier described in dancers. Because of the prolonged recovery time associated with this type of injury, correct diagnosis, based on history and palpation, and adequate information to the subject are essential.

Peroneal Tendon Reconstruction and Coverage for Treatment of Septic Peroneal Tenosynovitis: A Devastating Complication of Lateral Ankle Ligament Reconstruction With a Tendon Allograft.

PubMed

Schade, Valerie L; Harsha, Wayne; Rodman, Caitlin; Roukis, Thomas S

2016-01-01

Septic peroneal tenosynovitis is a rare and significant challenge. A search of peer-reviewed published studies revealed only 5 case reports to guide treatment, none of which resulted in significant loss of both peroneal tendons necessitating reconstruction. No clear guidance is available regarding how to provide reliable reconstruction of both peroneal tendons after a significant loss secondary to septic tenosynovitis. In the present report, we describe the case of a young, active-duty soldier who underwent lateral ankle ligament reconstruction with a tendon allograft whose postoperative course was complicated by septic peroneal tenosynovitis resulting in significant loss of both peroneal tendons. Reconstruction was achieved in a staged fashion with the use of silicone rods and external fixation to maintain physiologic tension and preserve peroneal tendon function, followed by reconstruction of both peroneal tendons and the superior peroneal retinaculum with a tensor fascia lata autograft. Soft tissue coverage was obtained with an anterolateral thigh free tissue transfer and a split-thickness skin graft. The patient returned to full activity as an active-duty soldier with minimal pain and no instability of the right lower extremity. The muscle strength of both peroneal tendons remained at 5 of 5, and no objective findings of ankle instability were seen at 3.5 years postoperatively. Published by Elsevier Inc.

Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling.

PubMed

Lacey, Matthew; Lamplot, Joseph; Walley, Kempland C; DeAngelis, Joseph P; Ramappa, Arun J

2017-05-18

To describe an approach to anterior cruciate ligament (ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary (IM) femoral nail. Once preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware (locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant and lateral wall soft tissues are removed from the intercondylar, to provide adequate visualization of the ACL footprint. Femoral tunnel placement is performed using a transportal ACL guide with desired offset and the knee flexed to 2.09 rad. The Beath pin is placed through the guide starting at the ACL's anatomic footprint using arthroscopic visualization and/or fluoroscopic guidance. If resistance is met while placing the Beath pin, the arthroscopy should be discontinued and the obstructing hardware should be removed under fluoroscopic guidance. When the Beath pin is successfully placed through the lateral femur, it is overdrilled with a 4.5 mm Endobutton drill. If the Endobutton drill is obstructed, the obstructing hardware should be removed under fluoroscopic guidance. In this case, the obstruction is more likely during Endobutton drilling due to its larger diameter and increased rigidity compared to the Beath pin. The femoral tunnel is then drilled using a best approximation of the graft's outer diameter. We recommend at least 7 mm diameter to minimize the risk of graft failure. Autologous hamstring grafts are generally between 6.8 and 8.6 mm in diameter. After reaming, the knee is flexed to 1.57 rad, the arthroscope placed through the anteromedial portal to confirm the femoral tunnel position, referencing the posterior wall and lateral cortex. For a quadrupled hamstring graft, the gracilis and semitendinosus tendons are then harvested in the standard fashion. The tendons are whip

The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players: study protocol for a randomised controlled trial.

PubMed

van der Horst, Nick; Smits, Dirk Wouter; Petersen, Jesper; Goedhart, Edwin A; Backx, Frank J G

2014-08-01

Hamstring injuries are the most common muscle injury in male amateur soccer players and have a high rate of recurrence, often despite extensive treatment and long rehabilitation periods. Eccentric strength and flexibility are recognised as important modifiable risk factors, which have led to the development of eccentric hamstring exercises, such as the Nordic hamstring exercise. As the effectiveness of the Nordic hamstring exercise in reducing hamstring injuries has never been investigated in amateur soccer players, the aim of this study is to investigate the effect of this exercise on the incidence and severity of hamstring injuries in male amateur soccer players. An additional aim is to determine whether flexibility is associated with hamstring injuries. Cluster-randomised controlled trial with soccer teams as the unit of cluster. Dutch male amateur soccer players, aged 18-40 years, were allocated to an intervention or control group. Both study groups continued regular soccer training during 2013, but the intervention group additionally performed the Nordic hamstring exercise (25 sessions over 13 weeks). Primary outcomes are the incidence of initial and recurrent hamstring injury and injury severity. Secondary outcomes are hamstring-and-lower-back flexibility and compliance. Compliance to the intervention protocol was also monitored. Eccentric hamstring strength exercises are hypothesised to reduce the incidence of hamstring injury among male amateur soccer players by 70%. The prevention of such injuries will be beneficial to soccer players, clubs, football associations, health insurance companies and society. NTR3664. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Graft position in arthroscopic anterior cruciate ligament reconstruction: anteromedial versus transtibial technique.

PubMed

Guler, Olcay; Mahırogulları, Mahir; Mutlu, Serhat; Cercı, Mehmet H; Seker, Ali; Cakmak, Selami

2016-11-01

When treating anterior cruciate ligament (ACL) injuries, the position of the ACL graft plays a key role in regaining postoperative knee function and physiologic kinematics. In this study, we aimed to compare graft angle, graft position in tibial tunnel, and tibial and femoral tunnel positions in patients operated with anteromedial (AM) and transtibial (TT) methods to those of contralateral healthy knees. Forty-eight patients who underwent arthroscopic ACL reconstruction with ipsilateral hamstring tendon autograft were included. Of these, 23 and 25 were treated by AM and TT techniques, respectively. MRI was performed at 18.4 and 19.7 months postoperatively in AM and TT groups. Graft angles, graft positions in the tibial tunnel and alignment of tibial and femoral tunnels were noted and compared in these two groups. The sagittal graft insertion tibia midpoint distance (SGON) has been used for evaluation of graft position in tunnel. Sagittal ACL graft angles in operated and healthy knees of AM patients were 57.78° and 46.80° (p < 0.01). With respect to TT patients, ACL graft angle was 58.87° and 70.04° on sagittal and frontal planes in operated knees versus 47.38° and 61.82° in healthy knees (p < 0.001). ACL graft angle was significantly different between the groups on both sagittal and frontal planes (p < 0.001). Sagittal graft insertion tibia midpoint distance ratio was 0.51 and 0.48 % in the operated and healthy knees of AM group (p < 0.001) and 0.51 and 0.48 % in TT group (p < 0.001). Sagittal tibial tunnel midpoint distance ratio did not differ from sagittal graft insertion tibia midpoint distance of healthy knees in either group. Femoral tunnel clock position was better in AM [right knee 10:19 o'clock-face position (310° ± 4°); left knee 1:40 (50° ± 3°)] compared with TT group [right knee 10:48 (324° ± 5°); left knee 1:04 (32° ± 4°)]. With respect to the sagittal plane, the anterior-posterior position of femoral tunnel was

Prevention of Hamstring Injuries in Collegiate Sprinters

PubMed Central

Sugiura, Yusaku; Sakuma, Kazuhiko; Sakuraba, Keishoku; Sato, Yamato

2017-01-01

Background: No studies have been reported on how strength, agility, and flexibility training reduce the occurrence of hamstring injuries in sprinters. Therefore, a program for preventing hamstring injury in these athletes has not been established. Purpose: To document the incidence of hamstring injuries during times when different prevention strategies were employed to see whether a particular prevention program reduced their occurrence. Study Design: Descriptive epidemiology study. Methods: The study subjects were a total of 613 collegiate male sprinters trained by the same coach over 24 seasons. Tow training was used throughout the research period as a normal sprint training method. The hamstring injury prevention program evolved over time. From 1988 to 1991 (period 1), prevention focused on strength training alone; from 1992 to 1999 (period 2), a combination of strength and agility training was used; and from 2000 to 2011 (period 3), the program incorporated strength, agility, and flexibility training. The incidence of hamstring injuries was compared for each of the 3 prevention strategies. Results: The incidence of hamstring injuries per athlete-seasons was 137.9 for period 1, 60.6 for period 2, and 6.7 for period 3. A significant difference was observed in the incidence of hamstring injury according to the different prevention programs (χ2(2) = 31.78, P < .001, effect size: Cramer V = 0.23, 1 − β = 0.999). Residual analysis showed that the number of hamstring injuries for period 1 was significantly greater than the expected value (P < .01), whereas that for period 3 was significantly lower than the expected value (P < .01). Conclusion: The incidence of hamstring injuries in sprinters decreased as agility and flexibility were added to strength training. PMID:28210652

Strength deficits identified with concentric action of the hip extensors and eccentric action of the hamstrings predispose to hamstring injury in elite sprinters.

PubMed

Sugiura, Yusaku; Saito, Tomoyuki; Sakuraba, Keishoku; Sakuma, Kazuhiko; Suzuki, Eiichi

2008-08-01

Prospective cohort study. In this prospective cohort study of elite sprinters, muscle strength of the hip extensors, as well as of the knee extensors and flexors, was measured to determine a possible relationship between strength deficits and subsequent hamstring injury within 12 months of testing. The method used for testing muscle strength simulated the specific muscle action during late swing and early contact phases when sprinting. There have been no prospective studies in elite sprinters that examine the concentric and eccentric isokinetic strength of the hip extensors and the quadriceps and hamstring muscles in a manner that reflects their actions in late swing or early contact phases of sprinting. Consequently, the causal relationship between hip and thigh muscle strength and hamstring injury in elite sprinters may not be fully understood. Isokinetic testing was performed on 30 male elite sprinters to assess hip extensors, quadriceps, and hamstring muscle strength. The occurrence of hamstring injury among the subjects was determined during the year following the muscle strength measurements. The strength of the hip extensors, quadriceps, and hamstring muscles, as well as the hamstrings-quadriceps and hip extensors- quadriceps ratios were compared. Hamstring injury occurred in 6 subjects during the 1-year period. Isokinetic testing at a speed of 60 degrees /s revealed weakness of the injured limb with eccentric action of the hamstring muscles and during concentric action of the hip extensors. When performing a side-to-side comparison for the injured sprinters, the hamstring injury always occurred on the weaker side. Differences in the hamstrings-quadriceps and hip extensors-quadriceps strength ratios were also evident between uninjured and injured limbs, and this was attributable to deficits in hamstring strength. Hamstring injury in elite sprinters was associated with weakness during eccentric action of the hamstrings and weakness during concentric action of

Tendon Reconstruction with Tissue Engineering Approach--A Review.

PubMed

Verdiyeva, Gunay; Koshy, Kiron; Glibbery, Natalia; Mann, Haroon; Seifalian, Alexander M

2015-09-01

Tendon injuries are a common and rising occurrence, associated with significant impairment to quality of life and financial burden to the healthcare system. Clinically, they represent an unresolved problem, due to poor natural tendon healing and the inability of current treatment strategies to restore the tendon to its native state. Tissue engineering offers a promising alternative, with the incorporation of scaffolds, cells and growth factors to support the complete regeneration of the tendon. The materials used in tendon engineering to date have provided significant advances in structural integrity and biological compatibility and in many cases the results obtained are superior to those observed in natural healing. However, grafts fail to reproduce the qualities of the pre-injured tendon and each has weaknesses subject to its constituent parts. Furthermore, many materials and cell types are being investigated concurrently, with seemingly little association or comparison between research results. In this review the properties of the most-investigated and effective components have been appraised in light of the surrounding literature, with research from early in-vitro experiments to clinical trials being discussed. Extensive comparisons have been made between scaffolds, cell types and growth factors used, listing strengths and weaknesses to provide a stable platform for future research. Promising future endeavours are also described in the field of nanocomposite material science, stem cell sources and growth factors, which may bypass weaknesses found in individual elements. The future of tendon engineering looks bright, with growing understanding in material technology, cell and growth factor application and encouraging recent advances bringing us ever closer to regenerating the native tendon.

Hamstrings strength imbalance in professional football (soccer) players in Australia.

PubMed

Ardern, Clare L; Pizzari, Tania; Wollin, Martin R; Webster, Kate E

2015-04-01

The aim of this study was to describe the isokinetic thigh muscle strength profile of professional male football players in Australia. Concentric (60° and 240°·s(-1)) and eccentric (30° and 120°·s(-1)) hamstrings and quadriceps isokinetic strength was measured with a HUMAC NORM dynamometer. The primary variables were bilateral concentric and eccentric hamstring and quadriceps peak torque ratios, concentric hamstring-quadriceps peak torque ratios, and mixed ratios (eccentric hamstring 30°·s(-1) ÷ concentric quadriceps 240°·s(-1)). Hamstring strength imbalance was defined as deficits in any 2 of: bilateral concentric hamstring peak torque ratio <0.86, bilateral eccentric hamstring peak torque ratio <0.86, concentric hamstring-quadriceps ratio <0.47, and mixed ratio <0.80. Fifty-five strength tests involving 42 players were conducted. Ten players (24%) were identified as having hamstring strength imbalance. Athletes with strength imbalance had significantly reduced concentric and eccentric bilateral hamstring peak torque ratios at all angular velocities tested; and reduced eccentric quadriceps peak torque (30°·s(-1)) in their stance leg, compared with those without strength imbalance. Approximately, 1 in 4 players had preseason hamstring strength imbalance; and all strength deficits were observed in the stance leg. Concentric and eccentric hamstrings strength imbalance may impact in-season football performance and could have implications for the future risk of injury.

Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture.

PubMed

Dejour, David; Saffarini, Mo; Demey, Guillaume; Baverel, Laurent

2015-10-01

Revision ACL reconstruction requires careful analysis of failure causes particularly in cases of two previous graft ruptures. Intrinsic factors as excessive tibial slope or narrow femoral notch increase failure risks but are rarely addressed in revision surgery. The authors report outcomes, at minimum follow-up of 2 years, for second revision ACL reconstructions combined with tibial deflexion osteotomy for correction of excessive slope (>12°). Nine patients that underwent second revision ACL reconstruction combined with tibial deflexion osteotomy were retrospectively studied. The mean age was 30.3 ± 4.4 years (median 28; range 26-37), and mean follow-up was 4.0 ± 2.0 years (median 3.6; range 2.0-7.6). Autografts were harvested from the quadriceps tendon (n = 8) or hamstrings (n = 1), and tibial osteotomy was done by anterior closing wedge, without detachment of the patellar tendon, to obtain a slope of 3° to 5°. All patients had fused osteotomies, stable knees, and there were no intraoperative or postoperative complications. The mean posterior tibial slope decreased from 13.2° ± 2.6° (median 13°; range 12°-18°) preoperatively to 4.4° ± 2.3° (median 4°; range 2°-8°) postoperatively. The mean Lysholm score was 73.8 ± 5.8 (median 74; range 65-82), and the IKDC-SKF was 71.6 ± 6.1 (median 72.8; range 62.2-78.5). The satisfactory results of second revision ACL reconstruction combined with tibial deflexion osteotomy at minimum follow-up of 2 years suggest that tibia slope correction protects reconstructed ACL from fatigue failure in this study. The authors stress the importance of careful analysis failure causes prior to revision ACL reconstruction, and recommend correction of tibial slope if it exceeds 12°, to reduce the risks of graft retear. III.

Prediction of hamstring injury in professional soccer players by isokinetic measurements

PubMed Central

Dauty, Marc; Menu, Pierre; Fouasson-Chailloux, Alban; Ferréol, Sophie; Dubois, Charles

2016-01-01

Summary Objectives previous studies investigating the ability of isokinetic strength ratios to predict hamstring injuries in soccer players have reported conflicting results. Hypothesis to determine if isokinetic ratios are able to predict hamstring injury occurring during the season in professional soccer players. Study Design case-control study; Level of evidence: 3. Methods from 2001 to 2011, 350 isokinetic tests were performed in 136 professional soccer players at the beginning of the soccer season. Fifty-seven players suffered hamstring injury during the season that followed the isokinetic tests. These players were compared with the 79 uninjured players. The bilateral concentric ratio (hamstring-to-hamstring), ipsilateral concentric ratio (hamstring-to-quadriceps), and mixed ratio (eccentric/concentric hamstring-to-quadriceps) were studied. The predictive ability of each ratio was established based on the likelihood ratio and post-test probability. Results the mixed ratio (30 eccentric/240 concentric hamstring-to-quadriceps) <0.8, ipsilateral ratio (180 concentric hamstring-to-quadriceps) <0.47, and bilateral ratio (60 concentric hamstring-to-hamstring) <0.85 were the most predictive of hamstring injury. The ipsilateral ratio <0.47 allowed prediction of the severity of the hamstring injury, and was also influenced by the length of time since administration of the isokinetic tests. Conclusion isokinetic ratios are useful for predicting the likelihood of hamstring injury in professional soccer players during the competitive season. PMID:27331039

THE EFFECT OF A PELVIC COMPRESSION BELT ON FUNCTIONAL HAMSTRING MUSCLE ACTIVITY IN SPORTSMEN WITH AND WITHOUT PREVIOUS HAMSTRING INJURY.

PubMed

Arumugam, Ashokan; Milosavljevic, Stephan; Woodley, Stephanie; Sole, Gisela

2015-06-01

There is evidence that applying a pelvic compression belt (PCB) can decrease hamstring and lumbar muscle electromyographic activity and increase gluteus maximus activity in healthy women during walking. Increased isokinetic eccentric hamstring strength in the terminal range (25 ° - 5 °) of knee extension has been reported with the use of such a belt in sportsmen with and without hamstring injuries. However, it is unknown whether wearing a pelvic belt alters activity of the hamstrings in sportsmen during walking. To examine the effects of wearing a PCB on electromyographic activity of the hamstring and lumbopelvic muscles during walking in sportsmen with and without hamstring injuries. Randomised crossover, cross-sectional study. Thirty uninjured sportsmen (23.53 ± 3.68 years) and 20 sportsmen with hamstring injuries (22.00 ± 1.45 years) sustained within the previous 12 months participated in this study. Electromyographic amplitudes of the hamstrings, gluteus maximus, gluteus medius and lumbar multifidus were monitored during defined phases of walking and normalised to maximum voluntary isometric contraction. Within-group comparisons [PCB vs. no PCB] for the normalised electromyographic amplitudes were performed for each muscle group using paired t tests. Electromyographic change scores [belt - no belt] were calculated and compared between the two groups with independent t tests. No significant change was evident in hamstring activity for either group while walking with the PCB (p > 0.050). However, with the PCB, gluteus medius activity (p ≤ 0.028) increased in both groups, while gluteus maximus activity increased (p = 0.025) and multifidus activity decreased (p < 0.001) in the control group. The magnitude of change induced by the PCB in gluteus medius activity was similar between groups (p = 0.760). No statistically significant baseline differences in no belt scores were evident between groups for the investigated muscles (p ≥ 0

The preventive effect of the nordic hamstring exercise on hamstring injuries in amateur soccer players: a randomized controlled trial.

PubMed

van der Horst, Nick; Smits, Dirk-Wouter; Petersen, Jesper; Goedhart, Edwin A; Backx, Frank J G

2015-06-01

Hamstring injuries are the most common muscle injuries in soccer, and they have a high rate of recurrence. Eccentric hamstrings strength is recognized as an important modifiable risk factor. This led to the development of prevention exercises such as the nordic hamstring exercise (NHE). The effectiveness of the NHE on hamstring injury prevention has never been investigated in amateur soccer. To investigate the preventive effect of the NHE on the incidence and severity of hamstring injuries in male amateur soccer players. Randomized controlled trial; Level of evidence, 1. Male amateur soccer players (age, mean ± SD, 24.5 ± 3.8 years) from 40 teams were randomly allocated to an intervention (n = 20 teams, 292 players) or control group (n = 20 teams, 287 players). The intervention group was instructed to perform 25 sessions of NHE in a 13-week period. Both the intervention and control groups performed regular soccer training and were followed for hamstring injury incidence and severity during the 2013 calendar year. At baseline, personal characteristics (eg, age, injury history, field position) were gathered from all participants via a questionnaire. Primary outcome was injury incidence. Secondary outcomes were injury severity and compliance with the intervention protocol. A total of 38 hamstring injuries were recorded, affecting 36 of 579 players (6.2%). The overall injury incidence rate was 0.7 (95% CI, 0.6-0.8) per 1000 player hours, 0.33 (95% CI, 0.25-0.46) in training, and 1.2 (95% CI, 0.82-1.94) in matches. Injury incidence rates were significantly different between the intervention (0.25; 95% CI, 0.19-0.35) and control groups (0.8; 95% CI, 0.61-1.15), χ(2)(1, n = 579) = 7.865; P = .005. The risk for hamstring injuries was reduced in the intervention group compared with the control group (odds ratio, 0.282; 95% CI, 0.110-0.721) and was statistically significant (P = .005). No statistically significant differences were identified between the intervention and

Anatomic ACL reconstruction: does the platelet-rich plasma accelerate tendon healing?

PubMed

Silva, Alcindo; Sampaio, Ricardo

2009-06-01

Recently, the use of hamstring tendons in anterior cruciate ligament repair has been increasing. However, tendon-to-bone healing occurs slowly, which can be a problem to an early return to sport activities. The use of growth factors from platelets seems to improve tissue healing. We enrolled 40 patients in a prospective study that were submitted to an anatomic reconstruction of the anterior cruciate ligament. Patients were sequentially enrolled into four groups: group A without platelet-rich plasma (PRP); group B with PRP in femoral tunnels at the end of surgery; group C with PRP in femoral tunnels at the end of surgery and intra-articular at 2- and 4 weeks after surgery; group D with PRP activated with thrombin in the femoral tunnels. All patients underwent magnetic resonance imaging of the knee 3 months after surgery to evaluate the signal intensity of the fibrous interzone (FIZ) in the femoral tunnels. We did not find any difference among the groups when comparing the signal intensity of the FIZ on magnetic resonance imaging.

Outcomes and complications following graft reconstruction for anterior sternoclavicular joint instability.

PubMed

Willinger, Lukas; Schanda, Jakob; Herbst, Elmar; Imhoff, Andreas B; Martetschläger, Frank

2016-12-01

Publications describing tendon graft reconstruction for anterior sternoclavicular joint (SCJ) instability are rare and usually refer to small patient numbers. The aim of this study was to systematically review the literature regarding outcomes and complications following tendon graft reconstruction techniques for anterior SCJ instability. An online database was systematically searched to identify studies on graft reconstruction for anterior SCJ instability. Reported outcome scores were graded as excellent, good, fair and poor to summarize the study results. All reported complications were recorded. Five articles with a total of 80 patients met the inclusion criteria. Reported outcomes were excellent in 10 %, good in 89 % and fair in 1 %. Recurrent instability was found in 10 % of the patients, and 5 % underwent revision surgery due to persistent impairment of shoulder function related to SCJ instability or osteoarthritis. Surgical stabilization techniques for the SCJ using autologous tendon grafts have shown to be safe and reliable and make better patients' pain situation and shoulder function. However, a certain amount of impairment might persist, which needs to be discussed with patients. Severe complications were rare and revision rates were as low as 5 %. Therefore, graft reconstruction techniques should be considered for patients with chronic anterior SCJ instability after a course of failed conservative treatment. This study is valuable for clinicians in daily clinical practice when dealing with this difficult-to-treat pathology and can help surgeons to better predict the clinical outcomes and complications following SCJ graft reconstruction. It should, however, not lead to underestimation of the potential risks of the procedure. Systematic review, Level IV.

Tendon Reattachment to Bone in an Ovine Tendon Defect Model of Retraction Using Allogenic and Xenogenic Demineralised Bone Matrix Incorporated with Mesenchymal Stem Cells.

PubMed

Thangarajah, Tanujan; Shahbazi, Shirin; Pendegrass, Catherine J; Lambert, Simon; Alexander, Susan; Blunn, Gordon W

2016-01-01

Tendon-bone healing following rotator cuff repairs is mainly impaired by poor tissue quality. Demineralised bone matrix promotes healing of the tendon-bone interface but its role in the treatment of tendon tears with retraction has not been investigated. We hypothesized that cortical demineralised bone matrix used with minimally manipulated mesenchymal stem cells will result in improved function and restoration of the tendon-bone interface with no difference between xenogenic and allogenic scaffolds. In an ovine model, the patellar tendon was detached from the tibial tuberosity and a complete distal tendon transverse defect measuring 1 cm was created. Suture anchors were used to reattach the tendon and xenogenic demineralised bone matrix + minimally manipulated mesenchymal stem cells (n = 5), or allogenic demineralised bone matrix + minimally manipulated mesenchymal stem cells (n = 5) were used to bridge the defect. Graft incorporation into the tendon and its effect on regeneration of the enthesis was assessed using histomorphometry. Force plate analysis was used to assess functional recovery. Compared to the xenograft, the allograft was associated with significantly higher functional weight bearing at 6 (P = 0.047), 9 (P = 0.028), and 12 weeks (P = 0.009). In the allogenic group this was accompanied by greater remodeling of the demineralised bone matrix into tendon-like tissue in the region of the defect (p = 0.015), and a more direct type of enthesis characterized by significantly more fibrocartilage (p = 0.039). No failures of tendon-bone healing were noted in either group. Demineralised bone matrix used with minimally manipulated mesenchymal stem cells promotes healing of the tendon-bone interface in an ovine model of acute tendon retraction, with superior mechanical and histological results associated with use of an allograft.

Hamstring strength and flexibility after hamstring strain injury: a systematic review and meta-analysis.

PubMed

Maniar, Nirav; Shield, Anthony J; Williams, Morgan D; Timmins, Ryan G; Opar, David A

2016-08-01

To systematically review the evidence base related to hamstring strength and flexibility in previously injured hamstrings. Systematic review and meta-analysis. A systematic literature search was conducted of PubMed, CINAHL, SPORTDiscus, Cochrane Library, Web of Science and EMBASE from inception to August 2015. Full-text English articles which included studies which assessed at least one measure of hamstring strength or flexibility in men and women with prior hamstring strain injury within 24 months of the testing date. Twenty-eight studies were included in the review. Previously injured legs demonstrated deficits across several variables. Lower isometric strength was found <7 days postinjury (d=-1.72), but this did not persist beyond 7 days after injury. The passive straight leg raise was restricted at multiple time points after injury (<10 days, d=-1.12; 10-20 days, d=-0.74; 20-30 days, d=-0.40), but not after 40-50 days postinjury. Deficits remained after return to play in isokinetically measured concentric (60°/s, d=-0.33) and Nordic eccentric knee flexor strength (d=-0.39). The conventional hamstring to quadricep strength ratios were also reduced well after return to play (60:60°/s, d=-0.32; 240:240°/s, d=-0.43) and functional (30:240°/s, d=-0.88), but these effects were inconsistent across measurement methods. After hamstring strain, acute isometric and passive straight leg raise deficits resolve within 20-50 days. Deficits in eccentric and concentric strength and strength ratios persist after return to play, but this effect was inconsistent across measurement methods. Flexibility and isometric strength should be monitored throughout rehabilitation, but dynamic strength should be assessed at and following return to play. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Implantation of a Novel Biologic and Hybridized Tissue Engineered Bioimplant in Large Tendon Defect: An In Vivo Investigation

PubMed Central

Oryan, Ahmad; Moshiri, Ali; Parizi, Abdolhamid Meimandi

2014-01-01

Surgical reconstruction of large Achilles tendon defects is technically demanding. There is no standard method, and tissue engineering may be a valuable option. We investigated the effects of 3D collagen and collagen-polydioxanone sheath (PDS) implants on a large tendon defect model in rabbits. Ninety rabbits were divided into three groups: control, collagen, and collagen-PDS. In all groups, 2 cm of the left Achilles tendon were excised and discarded. A modified Kessler suture was applied to all injured tendons to retain the gap length. The control group received no graft, the treated groups were repaired using the collagen only or the collagen-PDS prostheses. The bioelectrical characteristics of the injured areas were measured at weekly intervals. The animals were euthanized at 60 days after the procedure. Gross, histopathological and ultrastructural morphology and biophysical characteristics of the injured and intact tendons were investigated. Another 90 pilot animals were also used to investigate the inflammatory response and mechanism of graft incorporation during tendon healing. The control tendons showed severe hyperemia and peritendinous adhesion, and the gastrocnemius muscle of the control animals showed severe atrophy and fibrosis, with a loose areolar connective tissue filling the injured area. The tendons receiving either collagen or collagen-PDS implants showed lower amounts of peritendinous adhesion, hyperemia and muscle atrophy, and a dense tendon filled the defect area. Compared to the control tendons, application of collagen and collagen-PDS implants significantly improved water uptake, water delivery, direct transitional electrical current and tissue resistance to direct transitional electrical current. Compared to the control tendons, both prostheses showed significantly increased diameter, density and alignment of the collagen fibrils and maturity of the tenoblasts at ultrastructure level. Both prostheses influenced favorably tendon healing

Acute hamstring injury in football players: Association between anatomical location and extent of injury-A large single-center MRI report.

PubMed

Crema, Michel D; Guermazi, Ali; Tol, Johannes L; Niu, Jingbo; Hamilton, Bruce; Roemer, Frank W

2016-04-01

To describe in detail the anatomic distribution of acute hamstring injuries in football players, and to assess the relationship between location and extent of edema and tears, all based on findings from MRI. Retrospective observational study. We included 275 consecutive male football players who had sustained acute hamstring injuries and had positive findings on MRI. For each subject, lesions were recorded at specific locations of the hamstring muscles, which were divided into proximal or distal: free tendon, myotendinous junction, muscle belly, and myofascial junction locations. For each lesion, we assessed the largest cross-sectional area of edema and/or tears. We calculated the prevalence of injuries by location. The relationships between locations and extent of edema and tears were assessed using a one-sample t-test, with significance set at p<0.05. The long head of biceps femoris (LHBF) was most commonly affected (56.5%). Overall, injuries were most common in the myotendinous junction and in proximal locations. The proximal myotendinous junction was associated with a greater extent of edema in the LHBF and semitendinosus (ST) muscles (p<0.05). Proximal locations in the LHBF had larger edema than distal locations (p<0.05). Distal locations in the ST muscle had larger tears than proximal locations (p<0.05). The proximal myotendinous junction (LHBF and ST muscles) and proximal locations (LHBF muscle) are more commonly affected and are associated with a greater extent of edema in acute hamstring muscle injury. Distal locations (ST muscle), however, seem to be more commonly associated with larger tears. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Hamstring Injuries in the Athlete: Diagnosis, Treatment, and Return to Play.

PubMed

Chu, Samuel K; Rho, Monica E

2016-01-01

Hamstring injuries are very common in athletes. Acute hamstring strains can occur with high-speed running or with excessive hamstring lengthening. Athletes with proximal hamstring tendinopathy often do not report a specific inciting event; instead, they develop the pathology from chronic overuse. A thorough history and physical examination is important to determine the appropriate diagnosis and rule out other causes of posterior thigh pain. Conservative management of hamstring strains involves a rehabilitation protocol that gradually increases intensity and range of motion, and progresses to sport-specific and neuromuscular control exercises. Eccentric strengthening exercises are used for management of proximal hamstring tendinopathy. Studies investigating corticosteroid and platelet-rich plasma injections have mixed results. Magnetic resonance imaging and ultrasound are effective for identification of hamstring strains and tendinopathy but have not demonstrated correlation with return to play. The article focuses on diagnosis, treatment, and return-to-play considerations for acute hamstring strains and proximal hamstring tendinopathy in the athlete.

Hamstring Injuries in the Athlete: Diagnosis, Treatment, and Return to Play

PubMed Central

Chu, Samuel K.; Rho, Monica E.

2016-01-01

Hamstring injuries are very common in athletes. Acute hamstring strains can occur with high-speed running or with excessive hamstring lengthening. Athletes with proximal hamstring tendinopathy often do not report a specific inciting event; instead they develop the pathology from chronic overuse. A thorough history and examination is important to determine the appropriate diagnosis and rule out other causes of posterior thigh pain. Conservative management of hamstring strains involves a rehabilitation protocol that gradually increases intensity, range of motion and progresses to sport-specific and neuromuscular control exercises. Eccentric strengthening exercises are used for management of proximal hamstring tendinopathy. Studies investigating corticosteroid and platelet-rich plasma injections have mixed results. MRI and ultrasound are effective for identification of hamstring strains and tendinopathy, but have not demonstrated correlation with return to play. The article focuses on diagnosis, treatment and return to play considerations for acute hamstring strains and proximal hamstring tendinopathy in the athlete. PMID:27172083

Open capsular and ligament reconstruction with semitendinosus hamstring autograft successfully controls superior and posterior translation for type V acromioclavicular joint dislocation.

PubMed

Garofalo, Raffaele; Ceccarelli, Enrico; Castagna, Alessandro; Calvisi, Vittorio; Flanagin, Brody; Conti, Marco; Krishnan, Sumant G

2017-07-01

Appropriate surgical management for type V complete acromioclavicular (AC) joint dislocation remains controversial. The purpose of this paper is to retrospectively report the clinical and radiographic outcomes of an open surgical technique consisting for AC joint ligamentous and capsular reconstruction using autologous hamstring tendon grafts and semi-permanent sutures. Between January 2005 and December 2011, 32 consecutive patients with symptomatic type V complete AC joint dislocation underwent surgical treatment using the same technique. The median time from injury to surgery was 45 days (range 24-90). The average median postoperative clinical and radiographic follow-up time was 30 months (range 24-33). Clinical outcomes measures included the ASES score, the visual analog score (VAS), and subjective patient satisfaction score. Minimum follow-up was 2 years. ASES score increased from a median of 38.2 ± 6.2 preoperative to 92.1 ± 4.7 postoperatively (p ≤ 0.05). The median VAS score improved from 62 mm (range 45-100 mm) preoperatively to 8 mm (range 0-20 mm) at final follow-up (p ≤ 0.05). No patient experienced pain or discomfort with either direct palpation of the AC joint or with cross-body adduction. Final radiographs demonstrated symmetric AC joint contour in 25/32 (78%) patients. Seven patients (22%) radiographically demonstrated superior translation of the distal clavicle relative to the superior margin of the acromion but less than 50% of the clavicular width. 30/32 patients (93%) were able to return to their pre-injury level of work and sports activities. This novel surgical technique using a free graft and braided suture for simultaneous coracoclavicular ligament and AC joint capsular reconstruction successfully controls superior and posterior translations after type V AC joint dislocation and minimizes the incidence of persistent postoperative AC joint subluxation. Retrospective case series, Level IV.

Bioabsorbable versus metallic interference screws for graft fixation in anterior cruciate ligament reconstruction.

PubMed

Debieux, Pedro; Franciozi, Carlos E S; Lenza, Mário; Tamaoki, Marcel Jun; Magnussen, Robert A; Faloppa, Flávio; Belloti, João Carlos

2016-07-24

Anterior cruciate ligament (ACL) tears are frequently treated with surgical reconstruction with grafts, frequently patella tendon or hamstrings. Interference screws are often used to secure the graft in bone tunnels in the femur and tibia. This review examines whether bioabsorbable interference screws give better results than metal interference screws when used for graft fixation in ACL reconstruction. To assess the effects (benefits and harms) of bioabsorbable versus metallic interference screws for graft fixation in ACL reconstruction. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (the Cochrane Library), MEDLINE, Embase, LILACS, trial registers and reference lists of articles. Date of search: January 2016. We included randomised controlled trials and quasi-randomised trials comparing bioabsorbable with metallic interferences screws in ACL reconstruction. The main outcomes sought were subjective-rated knee function, failure of treatment, and activity level. At least two review authors selected eligible trials, independently assessed risk of bias, and cross-checked data. Data were pooled whenever relevant and possible. Requests for further information were sent to the original study authors. We included 12 trials (11 randomised and one quasi-randomised) involving a total of 944 participants, and reporting follow-up results for 774. Participants in the 12 trials underwent ACL reconstruction with either hamstring tendon grafts (five trials) or patellar tendon grafts (seven trials). Trials participants were randomly allocated to bioabsorbable or metallic interference screws for graft fixation in both femur and tibia (seven trials); femur only (three trials); tibia only (one trial); location was not reported in the remaining trial. A variety of materials was used for the bioabsorbable screws, Poly-L-lactic acid (PLLA) being the most common. The metallic screws, where reported, were titanium.All trials were at high risk of

Tendon healing in a bone tunnel. Part I: Biomechanical results after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep.

PubMed

Weiler, Andreas; Peine, Ricarda; Pashmineh-Azar, Alireza; Abel, Clemens; Südkamp, Norbert P; Hoffmann, Reinhard F G

2002-02-01

Interference fit fixation of soft-tissue grafts has recently raised strong interest because it allows for anatomic graft fixation that may increase knee stability and graft isometry. Although clinical data show promising results, no data exist on how tendon healing progresses using this fixation. The purpose of the present study was to investigate anterior cruciate ligament (ACL) reconstruction biomechanically using direct tendon-to-bone interference fit fixation with biodegradable interference screws in a sheep model. Animal study. Thirty-five mature sheep underwent ACL reconstruction with an autologous Achilles tendon split graft. Grafts were directly fixed with poly-(D,L-lactide) interference screws. Animals were euthanized after 6, 9, 12, 24, and 52 weeks and standard biomechanical evaluations were performed. All grafts at time zero failed by pullout from the bone tunnel, whereas grafts at 6 and 9 weeks failed intraligamentously at the screw insertion site. At 24 and 52 weeks, grafts failed by osteocartilaginous avulsion. At 24 weeks, interference screws were macroscopically degraded. At 6 and 9 weeks tensile stress was only 6.8% and 9.6%, respectively, of the graft tissue at time zero. At 52 weeks, tensile stress of the reconstruction equaled 63.8% and 47.3% of the Achilles tendon graft at time zero and the native ACL, respectively. A complete restitution of anterior-posterior drawer displacement was found at 52 weeks compared with the time-zero reconstruction. It was found that over the whole healing period the graft fixation proved not to be the weak link of the reconstruction and that direct interference fit fixation withstands loads without motion restriction in the present animal model. The weak link during the early healing stage was the graft at its tunnel entrance site, leading to a critical decrease in mechanical properties. This finding indicates that interference fit fixation of a soft-tissue graft may additionally alter the mechanical properties of

Soft tissue graft interference fit fixation: observations on graft insertion site healing and tunnel remodeling 2 years after ACL reconstruction in sheep.

PubMed

Hunt, Patrick; Rehm, Oliver; Weiler, Andreas

2006-12-01

Using soft tissue grafts for anterior cruciate ligament (ACL) reconstruction, insertion site healing plays a crucial role in the long-term fate of the graft. It has been shown in an experimental animal study that using a soft tissue graft and anatomic graft fixation, a direct ligamentous insertion alike the native ACL developed 24 weeks postoperatively. Yet there are no reports on the long-term insertion site healing of anatomically fixed soft tissue grafts. The objective of this study was to evaluate graft insertion site healing, the intra-tunnel fate of the graft and its osseous replacement 2 years after ACL reconstruction in sheep. The left ACLs of six sheep were replaced by an autologous flexor tendon split graft and anatomically fixed with biodegradable poly-(D, L-lactide) interference screws. Animals received polychromic sequential labeling at different points in time to determine bone apposition per period. For evaluation of the insertion site healing and intra-tunnel changes, MRI scans were taken in vivo. Following sacrifice, radiographic imaging, conventional histology and fluorescence microscopy was undertaken. Most of the specimens showed a wide direct ligamentous insertion. It showed patterns alike the direct ligament insertion seen in intact ACLs. The intra-tunnel part of the graft had completely lost its tendon-like structure and in two cases, it was separated from the graft insertion by a thick bony layer. The biodegradable interference screw was fully degraded in all specimens. Ossification of the former drill tunnels was intense, showing only partial-length tunnel remnants in one femoral and three tibial specimens. As the graft heals to the joint surface and the aperture site is closed with soft tissue, mechanical stress of the intra-tunnel part of the graft is eliminated and the bone tunnel is protected from synovial fluid, resulting in osseous bridging of the tunnel aperture site, accelerated intra-tunnel graft resorption and its osseous

Operative management of partial-thickness tears of the proximal hamstring muscles in athletes.

PubMed

Bowman, Karl F; Cohen, Steven B; Bradley, James P

2013-06-01

Partial tears of the hamstring muscle origin represent a challenging clinical problem to the patient and orthopaedic surgeon. Although nonoperative treatment is frequently met with limited success, there is a paucity of data on the efficacy of surgical management for partial proximal hamstring tears in the active and athletic population. To evaluate the results of an anatomic repair for partial tears of the hamstring muscle origin in athletes. Case series; Level of evidence, 4. The records of 17 patients with partial tears of the proximal hamstring origin were reviewed after institutional review board approval was obtained. All patients were treated with open debridement and primary tendon repair after failure of at least 6 months of nonoperative therapy. Clinical and operative records, radiographs, and magnetic resonance images were reviewed for all patients. A patient-reported outcomes survey was completed by 14 patients that included the Lower Extremity Functional Score (LEFS), Marx activity rating scale, custom LEFS and Marx scales, and subjective patient satisfaction scores. Early and late postoperative complications were recorded. There were 3 male and 14 female patients; their average age was 43 years (range, 19-64 years) and average follow-up was 32 months (range, 12-51 months). There were 2 collegiate athletes (field hockey, track), 14 amateur athletes (distance running, waterskiing, tennis), and a professional bodybuilder. Postoperative LEFS was 73.3 ± 9.9 (range, 50-80) and custom LEFS was 66.7 ± 17.0 (range, 37-80) of a maximum 80 points. The most commonly reported difficulty was with prolonged sitting and explosive direction change while running. The average Marx score was 6.5 ± 5.3 (range, 0-16) of a maximum 16, correlating with a greater return to recreational running activities in this patient cohort than regular participation in pivoting or cutting sports. Marx custom scores were 20 of a maximum 20 in all patients, demonstrating no disability in

Decline eccentric squats increases patellar tendon loading compared to standard eccentric squats.

PubMed

Kongsgaard, M; Aagaard, P; Roikjaer, S; Olsen, D; Jensen, M; Langberg, H; Magnusson, S P

2006-08-01

Recent studies have shown excellent clinical results using eccentric squat training on a 25 degrees decline board to treat patellar tendinopathy. It remains unknown why therapeutic management of patellar tendinopathy using decline eccentric squats offer superior clinical efficacy compared to standard horizontal eccentric squats. This study aimed to compare electromyography activity, patellar tendon strain and joint angle kinematics during standard and decline eccentric squats. Thirteen subjects performed unilateral eccentric squats on flat-and a 25 degrees decline surface. During the squats, electromyography activity was obtained in eight representative muscles. Also, ankle, knee and hip joint goniometry was obtained. Additionally, patellar tendon strain was measured in vivo using ultrasonography as subjects maintained a unilateral isometric 90 degrees knee angle squat position on either flat or 25 degrees decline surface. Patellar tendon strain was significantly greater (P<0.05) during the squat position on the decline surface compared to the standard surface. The stop angles of the ankle and hip joints were significantly smaller during the decline compared to the standard squats (P<0.001, P<0.05). Normalized mean electromyography amplitudes of the knee extensor muscles were significantly greater during the decline compared to the standard squats (P<0.05). Hamstring and calf muscle mean electromyography did not differ, respectively, between standard and decline squats. The use of a 25 degrees decline board increases the load and the strain of the patellar tendon during unilateral eccentric squats. This finding likely explains previous reports of superior clinical efficacy of decline eccentric squats in the rehabilitative management of patellar tendinopathy.

Hamstring Muscle Injuries, a Rehabilitation Protocol Purpose.

PubMed

Valle, Xavier; L Tol, Johannes; Hamilton, Bruce; Rodas, Gil; Malliaras, Peter; Malliaropoulos, Nikos; Rizo, Vicenc; Moreno, Marcel; Jardi, Jaume

2015-12-01

Hamstring acute muscle injuries are prevalent in several sports including AFL football (Australian Football League), sprinting and soccer, and are often associated with prolonged time away from sport. In response to this, research into prevention and management of hamstring injury has increased, but epidemiological data shows no decline in injury and re-injury rates, suggesting that rehabilitation programs and return to play (RTP) criteria have to be improved. There continues to be a lack of consensus regarding how to assess performance, recovery and readiness to RTP, following hamstring strain injury. The aim of this paper was to propose rehabilitation protocol for hamstring muscle injuries based on current basic science and research knowledge regarding injury demographics and management options. Criteria-based (subjective and objective) progression through the rehabilitation program will be outlined along with exercises for each phase, from initial injury to RTP.

[Avulsion of the Proximal Hamstring Insertion. Case Reports].

PubMed

Mizera, R; Harcuba, R; Kratochvíl, J

2016-01-01

Proximal hamstring avulsion is an uncommon muscle injury with a lack of consensus on indications and the timing and technique of surgery. Poor clinical symptoms and difficulties in the diagnostic process can lead to a false diagnosis. The authors present three cases of proximal hamstring avulsion, two complete and one partial ruptures of the biceps femoris muscle. MRI and ultrasound scans were used for optimal treatment alignment. Acute surgery reconstruction (< 4 weeks) was done in two patients. Re-attachment of the full thickness ruptures was performed to the original place and secured by suture anchors, the partial rupture was fixed by a simple suture. Two patients were free of any symptoms at 6 months after surgery, the last one had pain in the subgluteal area and a mild deficit in hamstring strength. Two interesting systematic reviews published on the treatment of proximal hamstring avulsion are discussed in the final part of the paper. Key words: hamstring, rupture, avulsion.

Impact of exercise selection on hamstring muscle activation.

PubMed

Bourne, Matthew N; Williams, Morgan D; Opar, David A; Al Najjar, Aiman; Kerr, Graham K; Shield, Anthony J

2017-07-01

To determine which strength training exercises selectively activate the biceps femoris long head (BF LongHead ) muscle. We recruited 24 recreationally active men for this two-part observational study . Part 1: We explored the amplitudes and the ratios of lateral (BF) to medial hamstring (MH) normalised electromyography (nEMG) during the concentric and eccentric phases of 10 common strength training exercises. Part 2: We used functional MRI (fMRI) to determine the spatial patterns of hamstring activation during two exercises which (1) most selectively and (2) least selectively activated the BF in part 1. Eccentrically, the largest BF/MH nEMG ratio occurred in the 45° hip-extension exercise; the lowest was in the Nordic hamstring (Nordic) and bent-knee bridge exercises. Concentrically, the highest BF/MH nEMG ratio occurred during the lunge and 45° hip extension; the lowest was during the leg curl and bent-knee bridge. fMRI revealed a greater BF (LongHead) to semitendinosus activation ratio in the 45° hip extension than the Nordic (p<0.001). The T2 increase after hip extension for BF LongHead , semitendinosus and semimembranosus muscles was greater than that for BF ShortHead (p<0.001). During the Nordic, the T2 increase was greater for the semitendinosus than for the other hamstring muscles (p≤0.002). We highlight the heterogeneity of hamstring activation patterns in different tasks. Hip-extension exercise selectively activates the long hamstrings, and the Nordic exercise preferentially recruits the semitendinosus. These findings have implications for strategies to prevent hamstring injury as well as potentially for clinicians targeting specific hamstring components for treatment (mechanotherapy). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The cross-sectional shape of the fourfold semitendinosus tendon is oval, not round.

PubMed

Oshima, Takeshi; Nakase, Junsuke; Numata, Hitoaki; Takata, Yasushi; Tsuchiya, Hiroyuki

2016-12-01

The looped side of the semitendinosus tendon (ST) graft (i.e., the side inserted into the femoral tunnel during anterior cruciate ligament reconstruction) appears to be oval rather than round. The purpose of this study was to investigate the cross section of the fourfold semitendinosus tendon graft and, more specifically, the differences in pressure exerted by a rounded rectangular tunnel versus a round femoral tunnel. Seven STs were harvested from cadaveric knees and a fourfold ST graft was made. Aluminum cubes with round or rectangular tunnels containing four-way pressure-sensitive conductive sensors (vertically and bilaterally) were used. The area of both cubes was the same. The graft was inserted into the tunnels 15 mm from the looped edge. After measuring pressure, the graft was fixed using ultraviolet-curing acrylic resin and was cut at 7.5 mm and 15 mm from the lapel edge. The area, axes for the best fitting ellipse of the cross-section, and ellipticity of the axes were measured. In the round tunnel, the mean contact pressure was 287.0 ± 136.7 gf at the bilateral sensor; there was no contact pressure detected by the vertical sensor. In the rounded rectangular tunnel, the mean contact pressure was 260.9 ± 186.4 gf at the bilateral sensor and 352.9 ± 49.5 gf at the vertical sensor. Ellipticity was 1.25 ± 0.13 at 7.5 mm, and 1.17 ± 0.07 at 15 mm from the lapel edge of the graft. The cross-sectional shape of the fourfold ST graft was not round, but oval. Moreover, the rounded rectangular tunnel was more fitted to the graft than the round tunnel.

Muscle recovery after ACL reconstruction with 4-strand semitendinosus graft harvested through either a posterior or anterior incision: a preliminary study.

PubMed

Dujardin, D; Fontanin, N; Geffrier, A; Morel, N; Mensa, C; Ohl, X

2015-09-01

Harvesting of a 4-strand semitendinosis (ST4) graft during anterior cruciate ligament (ACL) reconstruction can be performed through either a posterior or anterior approach. The objective of this study was to evaluate the recovery of the quadriceps and hamstring muscles as a function of the graft harvesting method. We hypothesized that posterior harvesting (PH) would lead to better recovery in hamstring strength than anterior harvesting (AH). In this prospective study, the semitendinosus was harvested through an anterior incision in the first group of patients and through a posterior one in the second group of patients. The patients were enrolled consecutively, without randomization. Isokinetic muscle testing was performed three and six months postoperative to determine the strength deficit in the quadriceps and hamstring muscles of the operated leg relative to the uninjured contralateral leg. Thirty-nine patients were included: 20 in the AH group and 19 in the PH group. The mean quadriceps strength deficit after three and six months was 42% and 26% for AH and 29% and 19% for the PH, respectively (P=0.01 after three months and P=0.16 after six months). The mean hamstring strength deficit after three and six months was 31% and 17% for AH and 23% and 15% for the PH, respectively (P=0.09 after three months and P=0.45 after six months). After three months, the PH group had recovered 12% more quadriceps muscle strength than the AH group (P=0.03). Our hypothesis was not confirmed. Harvesting of a ST4 graft for ACL reconstruction using a posterior approach led to better muscle strength recovery in the quadriceps only after three months. Level 3. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Region-dependent hamstrings activity in Nordic hamstring exercise and stiff-leg deadlift defined with high-density electromyography.

PubMed

Hegyi, A; Péter, A; Finni, T; Cronin, N J

2018-03-01

Recent studies suggest region-specific metabolic activity in hamstring muscles during injury prevention exercises, but the neural representation of this phenomenon is unknown. The aim of this study was to examine whether regional differences are evident in the activity of biceps femoris long head (BFlh) and semitendinosus (ST) muscles during two common injury prevention exercises. Twelve male participants without a history of hamstring injury performed the Nordic hamstring exercise (NHE) and stiff-leg deadlift (SDL) while BFlh and ST activities were recorded with high-density electromyography (HD-EMG). Normalized activity was calculated from the distal, middle, and proximal regions in the eccentric phase of each exercise. In NHE, ST overall activity was substantially higher than in BFlh (d = 1.06 ± 0.45), compared to trivial differences between muscles in SDL (d = 0.19 ± 0.34). Regional differences were found in NHE for both muscles, with different proximal-distal patterns: The distal region showed the lowest activity level in ST (regional differences, d range = 0.55-1.41) but the highest activity level in BFlh (regional differences, d range = 0.38-1.25). In SDL, regional differences were smaller in both muscles (d range = 0.29-0.67 and 0.16-0.63 in ST and BFlh, respectively) than in NHE. The use of HD-EMG in hamstrings revealed heterogeneous hamstrings activity during typical injury prevention exercises. High-density EMG might be useful in future studies to provide a comprehensive overview of hamstring muscle activity in other exercises and high-injury risk tasks. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Hand Surgeon Reporting of Tendon Rupture Following Distal Radius Volar Plating

PubMed Central

Monaco, Nathan A.; Dwyer, C. Liam; Ferikes, Alex J.; Lubahn, John D.

2016-01-01

Background: Volar plate fixation with locked screws has become the preferred treatment of displaced distal radius fractures that cannot be managed nonoperatively. This treatment, however, is not without complication. The purpose of this study was to determine what percentage of hand surgeons, over a 12-month period, have experienced a tendon complication when using volar plates for the treatment of distal radius fractures. Methods: A total of 3022 hand surgeons were e-mailed a link to an online questionnaire regarding their observation and treatment of tendon injuries associated with volar plating of distal radius fractures. Responses were reported using descriptive statistics. Results: Of the 596 (20%) respondents, 199 (33%) surgeons reported encountering at least one flexor tendon injury after distal radius volar plating over the past year of practice. The flexor pollicis longus was the most commonly reported tendon injury (254, 75%). Palmaris longus grafting (118, 37%) and tendon transfer (114, 36%) were the most often reported treatments following this complication. A total of 216 respondents (36%) also encountered 324 cases of extensor tendon rupture after volar plating of distal radius fractures, with tendon transfer (88%) being the preferred treatment option. Conclusions: Both flexor and extensor tendon ruptures can be seen after volar plating of distal radius fractures. Surgeons should be aware of these complications. Critical assessment of hardware position at the time of index procedure is recommended to avoid complications. Long-term studies are needed to standardize approaches to managing tendon rupture following volar plating of distal radius fractures. PMID:27698628

Hand Surgeon Reporting of Tendon Rupture Following Distal Radius Volar Plating.

PubMed

Monaco, Nathan A; Dwyer, C Liam; Ferikes, Alex J; Lubahn, John D

2016-09-01

Background: Volar plate fixation with locked screws has become the preferred treatment of displaced distal radius fractures that cannot be managed nonoperatively. This treatment, however, is not without complication. The purpose of this study was to determine what percentage of hand surgeons, over a 12-month period, have experienced a tendon complication when using volar plates for the treatment of distal radius fractures. Methods: A total of 3022 hand surgeons were e-mailed a link to an online questionnaire regarding their observation and treatment of tendon injuries associated with volar plating of distal radius fractures. Responses were reported using descriptive statistics. Results: Of the 596 (20%) respondents, 199 (33%) surgeons reported encountering at least one flexor tendon injury after distal radius volar plating over the past year of practice. The flexor pollicis longus was the most commonly reported tendon injury (254, 75%). Palmaris longus grafting (118, 37%) and tendon transfer (114, 36%) were the most often reported treatments following this complication. A total of 216 respondents (36%) also encountered 324 cases of extensor tendon rupture after volar plating of distal radius fractures, with tendon transfer (88%) being the preferred treatment option. Conclusions: Both flexor and extensor tendon ruptures can be seen after volar plating of distal radius fractures. Surgeons should be aware of these complications. Critical assessment of hardware position at the time of index procedure is recommended to avoid complications. Long-term studies are needed to standardize approaches to managing tendon rupture following volar plating of distal radius fractures.

Architectural differences between the hamstring muscles.

PubMed

Kellis, Eleftherios; Galanis, Nikiforos; Kapetanos, George; Natsis, Konstantinos

2012-08-01

The purpose of this study was to understand the detailed architectural properties of the human hamstring muscles. The long (BFlh) and short (BFsh) head of biceps femoris, semimembranosus (SM) and semitendinosus (ST) muscles were dissected and removed from their origins in eight cadaveric specimens (age 67.8±4.3 years). Mean fiber length, sarcomere length, physiological cross-section area and pennation angle were measured. These data were then used to calculate a similarity index (δ) between pairs of muscles. The results indicated moderate similarity between BFlh and BFsh (δ=0.54) and between BFlh and SM (δ=0.35). In contrast, similarity was low between SM and ST (δ=0.98) and between BFlh and SM (δ=1.17). The fascicle length/muscle length ratio was higher for the ST (0.58) and BFsh (0.50) compared with the BFlh (0.27) and SM (0.22). There were, however, high inter-correlations between individual muscle architecture values, especially for muscle thickness and fascicle length data sets. Prediction of the whole hamstring architecture was achieved by combining data from all four muscles. These data show different designs of the hamstring muscles, especially between the SM and ST (medial) and BFlh and BFsh (lateral) muscles. Modeling the hamstrings as one muscle group by assuming uniform inter-muscular architecture yields less accurate representation of human hamstring muscle function. Copyright © 2012 Elsevier Ltd. All rights reserved.

Hamstring Muscle Injuries, a Rehabilitation Protocol Purpose

PubMed Central

Valle, Xavier; L.Tol, Johannes; Hamilton, Bruce; Rodas, Gil; Malliaras, Peter; Malliaropoulos, Nikos; Rizo, Vicenc; Moreno, Marcel; Jardi, Jaume

2015-01-01

Context: Hamstring acute muscle injuries are prevalent in several sports including AFL football (Australian Football League), sprinting and soccer, and are often associated with prolonged time away from sport. Evidence Acquisition: In response to this, research into prevention and management of hamstring injury has increased, but epidemiological data shows no decline in injury and re-injury rates, suggesting that rehabilitation programs and return to play (RTP) criteria have to be improved. There continues to be a lack of consensus regarding how to assess performance, recovery and readiness to RTP, following hamstring strain injury. Results: The aim of this paper was to propose rehabilitation protocol for hamstring muscle injuries based on current basic science and research knowledge regarding injury demographics and management options. Conclusions: Criteria-based (subjective and objective) progression through the rehabilitation program will be outlined along with exercises for each phase, from initial injury to RTP. PMID:26715969

Effects of external pelvic compression on electromyographic activity of the hamstring muscles during unipedal stance in sportsmen with and without hamstring injuries.

PubMed

Arumugam, Ashokan; Milosavljevic, Stephan; Woodley, Stephanie; Sole, Gisela

2015-06-01

There is some evidence that hamstring function can be influenced by interventions focusing on the pelvis via an anatomic and neurophysiologic link between these two segments. Previous research demonstrated increased electromyographic activity from injured hamstrings during transition from bipedal to unipedal stance (BUS). The aim of this study was to investigate the effects of a pelvic compression belt (PCB) on electromyographic activity of selected muscles during BUS in sportsmen with and without hamstring injury. Electromyographic amplitudes (normalised to maximum voluntary isometric contraction [MVIC]) of the hamstrings, gluteus maximus, gluteus medius and lumbar multifidus were obtained during BUS from 20 hamstring-injured participants (both sides) and 30 healthy participants (one side, randomly selected). There was an increase in biceps femoris (by 1.23 ± 2.87 %MVIC; p = 0.027) and gluteus maximus (by 0.63 ± 1.13 %MVIC; p = 0.023) electromyographic activity for the hamstring-injured side but no significant differences other than a decrease in multifidus activity (by 1.36 ± 2.92 %MVIC; p = 0.023) were evident for healthy participants while wearing the PCB. However, the effect sizes for these findings were small. Wearing the PCB did not significantly change electromyographic activity of other muscles in either participant group (p > 0.050). Moreover, the magnitude of change induced by the PCB was not significantly different between groups (p > 0.050) for the investigated muscles. Thus, application of a PCB to decrease electromyographic activity of injured hamstrings during BUS is likely to have little effect. Similar research is warranted in participants with acute hamstring injury. Copyright © 2014 Elsevier Ltd. All rights reserved.

Repair of full-thickness tendon injury using connective tissue progenitors efficiently derived from human embryonic stem cells and fetal tissues.

PubMed

Cohen, Shahar; Leshansky, Lucy; Zussman, Eyal; Burman, Michael; Srouji, Samer; Livne, Erella; Abramov, Natalie; Itskovitz-Eldor, Joseph

2010-10-01

The use of stem cells for tissue engineering (TE) encourages scientists to design new platforms in the field of regenerative and reconstructive medicine. Human embryonic stem cells (hESC) have been proposed to be an important cell source for cell-based TE applications as well as an exciting tool for investigating the fundamentals of human development. Here, we describe the efficient derivation of connective tissue progenitors (CTPs) from hESC lines and fetal tissues. The CTPs were significantly expanded and induced to generate tendon tissues in vitro, with ultrastructural characteristics and biomechanical properties typical of mature tendons. We describe a simple method for engineering tendon grafts that can successfully repair injured Achilles tendons and restore the ankle joint extension movement in mice. We also show the CTP's ability to differentiate into bone, cartilage, and fat both in vitro and in vivo. This study offers evidence for the possibility of using stem cell-derived engineered grafts to replace missing tissues, and sets a basic platform for future cell-based TE applications in the fields of orthopedics and reconstructive surgery.

[Medial patellofemoral ligament reconstruction using quadriceps tendon].

PubMed

Lenschow, S; Herbort, M; Fink, C

2015-12-01

Stabilization of the patella by medial patellofemoral ligament (MPFL) reconstruction. Recurrent lateral patella instability with chronic weakening of the MPFL. Femoropatellar cartilage defects ICRS grade 3° or higher. Tuberositas Tibiae Trochlear Groove Index (TTTG) >20 mm. Lateral hypercompression of the patella without instability. A 3 cm transverse skin incision at the superomedial edge of the patella in 90° of flexion. Longitudinal incision of the prepatellar bursa and exposure of the quadriceps tendon. Preparation of a flat tendon strip with a length of 8 cm, a width of 10 mm, and a thickness of 3 mm, leaving the attachment at the patella intact. Flipping of the tendon strip and passing of the graft through a tunnel underneath the prepatellar tissue at the medial edge of the patella. Passing of the graft in layer two of the medial joint capsule just below the fascia (layer 1) and the vastus medialis. Fixation of the graft in a bone tunnel, drilled in the femoral insertion site of the native MPFL using a biodegradable interference screw. Patella centralizing brace for 4 weeks with range of motion (ROM) 0/0/90°, 20 kg of partial weight bearing for 3 weeks. Full weight-bearing according to pain starting from week 4 postoperatively. ROM up to 90° of flexion directly postoperatively. Free ROM starting from week 6 postoperatively. Stationary cycling 6 weeks postoperatively. Swimming and running after 10 months. Return to pivoting sports after 4-5 months. A total of 17 patients (7 men and 10 women; average age 21.5 years ±3.9 years, average BMI 22.6 ±3.9) were treated using this technique between March 2011 and November 2012. Only patients with at least one recurrent patella dislocation following conservative treatment were included. Patient satisfaction 12 months postoperatively was very high. Overall, 94.1 % would undergo the procedure again and 94.1 % were very satisfied with the cosmetic result. Significant improvement in Lysholm score 6, 12, and 24

Hamstring Injuries--An Examination of Possible Causes.

ERIC Educational Resources Information Center

Liemohn, Wendell

On the basis of research, the following characteristics appear to be important factors relative to precluding hamstring strains in sprinters: bilaterality relative to hamstring and quadricep strength development, optimum strength ratios between ipsilateral antagonists throughout the range of movement, and above-normal hip-joint flexibility. (JD)

Mechanics of the human hamstring muscles during sprinting.

PubMed

Schache, Anthony G; Dorn, Tim W; Blanch, Peter D; Brown, Nicholas A T; Pandy, Marcus G

2012-04-01

An understanding of hamstring mechanics during sprinting is important for elucidating why these muscles are so vulnerable to acute strain-type injury. The purpose of this study was twofold: first, to quantify the biomechanical load (specifically, musculotendon strain, velocity, force, power, and work) experienced by the hamstrings across a full stride cycle; and second, to determine how these parameters differ for each hamstring muscle (i.e., semimembranosus (SM), semitendinosus (ST), biceps femoris long head (BF), biceps femoris short head (BF)). Full-body kinematics and ground reaction force data were recorded simultaneously from seven subjects while sprinting on an indoor running track. Experimental data were integrated with a three-dimensional musculoskeletal computer model comprised of 12 body segments and 92 musculotendon structures. The model was used in conjunction with an optimization algorithm to calculate musculotendon strain, velocity, force, power, and work for the hamstrings. SM, ST, and BF all reached peak strain, produced peak force, and formed much negative work (energy absorption) during terminal swing. The biomechanical load differed for each hamstring muscle: BF exhibited the largest peak strain, ST displayed the greatest lengthening velocity, and SM produced the highest peak force, absorbed and generated the most power, and performed the largest amount of positive and negative work. As peak musculotendon force and strain for BF, ST, and SM occurred around the same time during terminal swing, it is suggested that this period in the stride cycle may be when the biarticular hamstrings are at greatest injury risk. On this basis, hamstring injury prevention or rehabilitation programs should preferentially target strengthening exercises that involve eccentric contractions performed with high loads at longer musculotendon lengths.

Fluoroscopically Guided Peritendinous Corticosteroid Injection for Proximal Hamstring Tendinopathy

PubMed Central

Nicholson, Luke T.; DiSegna, Steven; Newman, Joel S.; Miller, Suzanne L.

2014-01-01

Background: Proximal hamstring tendinopathy is an uncommon but debilitating cause of posterior thigh pain in athletes subjected to repetitive eccentric hamstring contraction, such as runners. Minimal data exist evaluating treatment options for proximal hamstring tendinopathy. Purpose: This retrospective study evaluates the effectiveness of fluoroscopically guided corticosteroid injections in treating proximal hamstring tendinopathy. Study Design: Case series; Level of evidence, 4. Methods: Eighteen athletes with 22 cases of magnetic resonance imaging–confirmed proximal hamstring tendinopathy were treated with corticosteroid injection and later contacted to evaluate the efficacy of the injection with the use of a questionnaire. Results: The visual analog score decreased from 7.22 preinjection to 3.94 postinjection (P < .001), level of athletic participation increased from 28.76% to 68.82% (P < .001) at a mean follow-up of 21 months, and 38.8% of patients experienced complete resolution at a mean follow-up of 24.8 months. The mean lower extremity function score at the time of follow-up was 60. Conclusion: A trial of fluoroscopically guided corticosteroid injection is warranted in patients presenting with symptoms of proximal hamstring tendinopathy refractory to conservative therapy. PMID:26535310

Biomechanical comparison between the rectangular-tunnel and the round-tunnel anterior cruciate ligament reconstruction procedures with a bone-patellar tendon-bone graft.

PubMed

Suzuki, Tomoyuki; Shino, Konsei; Otsubo, Hidenori; Suzuki, Daisuke; Mae, Tatsuo; Fujimiya, Mineko; Yamashita, Toshihiko; Fujie, Hiromichi

2014-10-01

The purpose of this study was to evaluate the effectiveness of 2 anterior cruciate ligament (ACL) reconstruction techniques using a bone-patellar tendon-bone (BPTB) graft with femoral tunnel, either a rectangular tunnel (RET) or a round tunnel (ROT). For experiment 1, nine fresh-frozen human cadaveric knees were tested with a robotic/universal force-moment sensor system to determine the initial optimal tension: the amount of graft tension at 15° of flexion most closely resembling the anterior laxity of a normal knee. The value was estimated by repeatedly measuring anterior laxity when 100 N of anteroposterior drawer load was applied to the knees at 30° of flexion after RET ACL or ROT ACL reconstruction. For experiment 2, six fresh-frozen human cadaveric knees were selected. On the basis of the initial tension determined in experiment 1, RET ACL reconstruction was conducted with the graft tensioned to 10 N, followed by ROT ACL reconstruction on the same knee at 40 N of initial tension, and the biomechanical efficacy of the 2 methods was compared. For experiment 1, the mean laxity match tension at 15° of flexion was 8.6 ± 4.8 N and 34.8 ± 9.2 N for RET- and ROT-reconstructed knees, respectively. For experiment 2, both RET and ROT ACL reconstructions were successful in controlling anterior tibial translation under anterior tibial loads, with the graft initially tensioned to 10 N in the former and to 40 N in the latter. However, the greater tensioning in ROT reconstruction led to proximal, posterior, and lateral displacement of the tibia along with its external and valgus rotation. The RET ACL-reconstructed knee more closely resembled the normal knee in biomechanical behavior. Although ROT reconstruction successfully controlled anterior translation with greater initial tensioning to the graft, the normal positional relation between the tibia and femur was impaired. Rectangular femoral ACL fixation constructs and grafts may prove more efficacious at

A New Technique for Surgical Treatment of Proximal Hamstring Tendinopathy in a Triathlon Athlete.

PubMed

Costa, Lincoln Paiva; Barros, Antônio Augusto Guimarães; Vassalo, Carlos Cesar; Sonnery-Cottet, Bertrand; Barbosa, Victor Atsushi Kasuya; Temponi, Eduardo Frois

2016-01-01

Proximal hamstring tendinopathy (PHT) is the result of chronic overload caused by repetitive eccentric contraction. Surgical treatment becomes an option for patients with chronic symptoms that do not respond to conservative treatment. This report describes a case of a 48-year-old man, an amateur triathlete, with deep gluteal pain in the left hip for 12 months, leading to a decline in sports performance. Magnetic resonance imaging revealed abnormalities that suggested a PHT. Surgery was indicated following the failure of conservative treatments. Debridement of the conjoint tendon and its reinsertion associated with semimembranosus tenotomy showed good results and is thus an option for the treatment of this pathology after 12 months of follow-up. This article provides surgeons with a new surgical option for this debilitating condition with clinical and functional improvement after 12 months of follow-up.

Surface Modification with Chemically Modified Synovial Fluid for Flexor Tendon Reconstruction in a Canine Model in Vivo

PubMed Central

Ji, Xiaoxi; Reisdorf, Ramona L.; Thoreson, Andrew R.; Berglund, Lawrence R.; Moran, Steven L.; Jay, Gregory D.; An, Kai-Nan; Amadio, Peter C.; Zhao, Chunfeng

2015-01-01

on tendon culture. Conclusions: Modification of the flexor tendon surface with cd-SF-G significantly improved digital function and reduced adhesion formation without affecting graft healing and stiffness. Clinical Relevance: This study used native synovial fluid as a basic lubricating reagent to treat a tendon graft in vivo, a novel avenue for improving clinical outcomes of flexor tendon reconstruction. This methodology may also apply to other surgical procedures where postoperative adhesions impair function. PMID:26085530

Tendon transfer fixation: comparing a tendon to tendon technique vs. bioabsorbable interference-fit screw fixation.

PubMed

Sabonghy, Eric Peter; Wood, Robert Michael; Ambrose, Catherine Glauber; McGarvey, William Christopher; Clanton, Thomas Oscar

2003-03-01

Tendon transfer techniques in the foot and ankle are used for tendon ruptures, deformities, and instabilities. This fresh cadaver study compares the tendon fixation strength in 10 paired specimens by performing a tendon to tendon fixation technique or using 7 x 20-25 mm bioabsorbable interference-fit screw tendon fixation technique. Load at failure of the tendon to tendon fixation method averaged 279N (Standard Deviation 81N) and the bioabsorbable screw 148N (Standard Deviation 72N) [p = 0.0008]. Bioabsorbable interference-fit screws in these specimens show decreased fixation strength relative to the traditional fixation technique. However, the mean bioabsorbable screw fixation strength of 148N provides physiologic strength at the tendon-bone interface.

Australian football players' Achilles tendons respond to game loads within 2 days: an ultrasound tissue characterisation (UTC) study.

PubMed

Rosengarten, Samuel D; Cook, Jill L; Bryant, Adam L; Cordy, Justin T; Daffy, John; Docking, Sean I

2015-02-01

The Achilles tendon is a tissue that responds to mechanical loads at a molecular and cellular level. In vitro and in vivo studies have shown that the expression of anabolic and/or catabolic proteins can change within hours of loading and return to baseline levels within 72 h. These biochemical changes have not been correlated with changes in whole tendon structure on imaging. We examined the nature and temporal sequence of changes in Achilles tendon structure in response to competitive game loads in elite Australian football players. Elite male Australian football players with no history of Achilles tendinopathy were recruited. Achilles tendon structure was quantified using ultrasound tissue characterisation (UTC) imaging, a valid and reliable measure of intratendinous structure, the day prior to the match (day 0), and then reimaged on days 1, 2 and 4 postgame. Of the 18 participants eligible for this study, 12 had no history of tendinopathy (NORM) and 6 had a history of patellar or hamstring tendinopathy (TEN). Differences in baseline UTC echopattern were observed between the NORM and TEN groups, with the Achilles of the TEN group exhibiting altered UTC echopattern, consistent with a slightly disorganised tendon structure. In the NORM group, a significant reduction in echo-type I (normal tendon structure) was seen on day 2 (p=0.012) that returned to baseline on day 4. There was a transient change in UTC echopattern in the Achilles tendon as a result of an Australian football game in individuals without a history of lower limb tendinopathy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Effects of Cupping on Hamstring Flexibility in Collegiate Soccer Players.

PubMed

Williams, Jeffrey G; Gard, Hannah I; Gregory, Jeana M; Gibson, Amy; Austin, Jennifer

2018-01-24

Collegiate soccer players suffer hamstring injuries due to inflexibility and repetitive motions involving intense hamstring lengthening and contraction during sport. Although a popular intervention for muscular injury, there exists limited evidence of the effects of therapeutic cupping on hamstring flexibility. To determine the effect of cupping therapy on hamstring flexibility in collegiate soccer players. Cohort design. Athletic training clinic. Twenty-five, asymptomatic, NCAA Division III soccer players (10 males, 15 females) (age = 19.4 ± 1.30 years, height = 175.1 ± 8.2 cm, mass = 69.5 ± 6.6 kg). A 7-minute therapeutic cupping treatment was delivered to the treatment group. Four 2-inch cups were fixed atop trigger point locations within the hamstring muscle bellies of participants' dominant legs. Control group participants received no intervention between pre- and post-test measurements. Pretest and posttest measurements of hamstring flexibility, using a Passive Straight Leg Raise (PSLR), were performed on both groups. PSLR measurements were conducted by blinded examiners using a digital inclinometer. An independent samples t-test was used to analyze changes in hamstring flexibility from pre- to post-treatment with p-values set a priori at 0.05. An independent samples t-test demonstrated no significant difference in change in hamstring flexibility between participants in the treatment group and those in the control group (t 23 = -.961, p = .35). The findings of this study demonstrated no statistically significant changes in hamstring flexibility following a cupping treatment.

Physical principles demonstrate that the biceps femoris muscle relative to the other hamstring muscles exerts the most force: implications for hamstring muscle strain injuries.

PubMed

Dolman, Bronwyn; Verrall, Geoffrey; Reid, Iain

2014-07-01

Of the hamstring muscle group the biceps femoris muscle is the most commonly injured muscle in sports requiring interval sprinting. The reason for this observation is unknown. The objective of this study was to calculate the forces of all three hamstring muscles, relative to each other, during a lengthening contraction to assess for any differences that may help explain the biceps femoris predilection for injury during interval sprinting. To calculate the displacement of each individual hamstring muscle previously performed studies on cadaveric anatomical data and hamstring kinematics during sprinting were used. From these displacement calculations for each individual hamstring muscle physical principles were then used to deduce the proportion of force exerted by each individual hamstring muscle during a lengthening muscle contraction. These deductions demonstrate that the biceps femoris muscle is required to exert proportionally more force in a lengthening muscle contraction relative to the semimembranosus and semitendinosus muscles primarily as a consequence of having to lengthen over a greater distance within the same time frame. It is hypothesized that this property maybe a factor in the known observation of the increased susceptibility of the biceps femoris muscle to injury during repeated sprints where recurrent higher force is required.

Hamstring Muscle Use in Females During Hip-Extension and the Nordic Hamstring Exercise: An fMRI Study.

PubMed

Messer, Daniel J; Bourne, Matthew N; Williams, Morgan D; Al Najjar, Aiman; Shield, Anthony J

2018-04-23

Study Design Cross-sectional study. Background Understanding hamstring muscle activation patterns in resistance training exercises may have implications for the design of strength training and injury prevention programs. Unfortunately, surface electromyography studies have reported conflicting results with regard to hamstring muscle activation patterns in women. Objectives To determine the spatial patterns of hamstring muscle activity during the 45º hip-extension and Nordic hamstring exercises, in females using functional magnetic resonance imaging. Methods Six recreationally active females with no history of lower limb injury underwent functional magnetic resonance imaging (fMRI) on both thighs before and immediately after 5 sets of 6 bilateral eccentric contractions of the 45º hip-extension or Nordic exercises. Using fMRI, the transverse (T2) relaxation times were measured from pre- and post- exercise scans and the percentage increase in T2 was used as an index of muscle activation. Results fMRI revealed a significantly higher biceps femoris long head (BF LongHead ) to semitendinosus ratio during the 45° hip-extension than the Nordic exercise (P = .028). The T2 increase after 45° hip-extension was greater for BF LongHead (P < .001), semitendinosus and semimembranosus (P = .001) than that of biceps femoris short head (BF ShortHead ). During the Nordic exercise, the T2 increase for semitendinosus was greater than that of BF ShortHead (P < .001) and BF LongHead (P = .001). Conclusion While both exercises involve high levels of semitendinosus activation in women, the Nordic exercise preferentially recruits that muscle while the hip extension more evenly activates all of the biarticular hamstrings. J Orthop Sports Phys Ther, Epub 23 Apr 2018. doi:10.2519/jospt.2018.7748.

Treatment of proximal hamstring tendinopathy-related sciatic nerve entrapment: presentation of an ultrasound-guided "Intratissue Percutaneous Electrolysis" application.

PubMed

Mattiussi, Gabriele; Moreno, Carlos

2016-01-01

Proximal Hamstring Tendinopathy-related Sciatic Nerve Entrapment (PHTrSNE) is a neuropathy caused by fibrosis interposed between the semimembranosus tendon and the sciatic nerve, at the level of the ischial tuberosity. Ultrasound-guided Intratissue Percutaneous Electrolysis (US-guided EPI) involves galvanic current transfer within the treatment target tissue (fibrosis) via a needle 0.30 to 0.33 mm in diameter. The galvanic current in a saline solution instantly develops the chemical process of electrolysis, which in turn induces electrochemical ablation of fibrosis. In this article, the interventional procedure is presented in detail, and both the strengths and limits of the technique are discussed. US-guided EPI eliminates the fibrotic accumulation that causes PHTrSNE, without the semimembranosus tendon or the sciatic nerve being directly involved during the procedure. The technique is however of limited use in cases of compression neuropathy. US-guided EPI is a technique that is quick to perform, minimally invasive and does not force the patient to suspend their activities (work or sports) to make the treatment effective. This, coupled to the fact that the technique is generally well-tolerated by patients, supports use of US-guided EPI in the treatment of PHTrSNE.

Tendon injuries

PubMed Central

Wu, Fan; Nerlich, Michael; Docheva, Denitsa

2017-01-01

Tendons connect muscles to bones, ensuring joint movement. With advanced age, tendons become more prone to degeneration followed by injuries. Tendon repair often requires lengthy periods of rehabilitation, especially in elderly patients. Existing medical and surgical treatments often fail to regain full tendon function. The development of novel treatment methods has been hampered due to limited understanding of basic tendon biology. Recently, it was discovered that tendons, similar to other mesenchymal tissues, contain tendon stem/progenitor cells (TSPCs) which possess the common stem cell properties. The current strategies for enhancing tendon repair consist mainly of applying stem cells, growth factors, natural and artificial biomaterials alone or in combination. In this review, we summarise the basic biology of tendon tissues and provide an update on the latest repair proposals for tendon tears. Cite this article: EFORT Open Rev 2017;2:332-342. DOI: 10.1302/2058-5241.2.160075 PMID:28828182

Tendon Tissue Engineering and Its Role on Healing of the Experimentally Induced Large Tendon Defect Model in Rabbits: A Comprehensive In Vivo Study

PubMed Central

Meimandi-Parizi, Abdolhamid; Oryan, Ahmad; Moshiri, Ali

2013-01-01

Healing of large tendon defects is challenging. We studied the role of collagen implant with or without polydioxanone (PDS) sheath on the healing of a large Achilles tendon defect model, in rabbits. Sixty rabbits were divided into three groups. A 2 cm gap was created in the left Achilles tendon of all rabbits. In the control lesions, no implant was used. The other two groups were reconstructed by collagen and collagen-PDS implants respectively. The animals were clinically examined at weekly intervals and their lesions were observed by ultrasonography. Blood samples were obtained from the animals and were assessed for hematological analysis and determination of serum PDGF level, at 60 days post injury (DPI). The animals were then euthanized and their lesions were assessed for gross and histopathology, scanning electron microscopy, biomechanical testing, dry matter and hydroxyproline content. Another 65 pilot animals were also studied grossly and histopathologically to define the host implant interaction and graft incorporation at serial time points. The treated animals gained significantly better clinical scoring compared to the controls. Treatment with collagen and collagen-PDS implants significantly increased the biomechanical properties of the lesions compared to the control tendons at 60DPI (P<0.05). The tissue engineered implants also reduced peritendinous adhesion, muscle fibrosis and atrophy, and increased ultrasonographical echogenicity and homogenicity, maturation and differentiation of the collagen fibrils and fibers, tissue alignment and volume of the regenerated tissue compared to those of the control lesions (P<0.05). The implants were gradually absorbed and substituted by the new tendon. Implantation of the bioimplants had a significant role in initiating tendon healing and the implants were biocompatible, biodegradable and safe for application in tendon reconstructive surgery. The results of the present study may be valuable in clinical practice. PMID

Rupture of the anterior tibial tendon: three clinical cases, anatomical study, and literature review.

PubMed

Anagnostakos, Konstantinos; Bachelier, Felix; Fürst, Oliver Alexander; Kelm, Jens

2006-05-01

We report three cases of anterior tibial tendon ruptures and the results of an anatomical study in regard to the tendon's insertion site and a literature review. Three patients were referred to our hospital with anterior tibial tendon ruptures. In the anatomical study, 53 feet were dissected, looking in particular for variants of the bony insertion of the tendon. Two patients had surgical treatment (one primary repair and one semimembranosus tendon graft) and one conservative treatment. After a mean followup of 14 weeks all patients had satisfactory outcomes. In the anatomical study, we noted three different insertion sites: in 36 feet the tendon inserted into the medial side of the cuneiform and the base of the first metatarsal bone and in 13 feet only into the medial side of the cuneiform bone. In the remaining four feet the tendon inserted into the cuneiform and the first metatarsal bone, but an additional tendon was noted taking its origin from the anterior tibial tendon near its insertion into the medial cuneiform and attaching to the proximal part of the first metatarsal. According to literature, surgical repair is the treatment of choice for acute ruptures and for patients with high activity levels. For chronic ruptures and patients with low demands, conservative management may lead to an equally good outcome. Knowledge of the anatomy in this region may be helpful for diagnosis and for the interpretation of intraoperative findings and choosing the most appropriate surgical procedure.

Flexion relaxation of the hamstring muscles during lumbar-pelvic rhythm.

PubMed

Sihvonen, T

1997-05-01

This study investigated the simultaneous activity of back muscles and hamstring muscles during sagittal forward body flexion and extension in healthy persons. The study was cross-sectional. A descriptive study of paraspinal and hamstring muscle activity in normal persons during lumbar-pelvic rhythm. A university hospital. Forty healthy volunteers (21 men, 19 women, ages 17 to 48 years), all without back pain or other pain syndromes. Surface electromyography (EMG) was used to follow activities in the back and the hamstring muscles. With movement sensors, real lumbar flexion was separated from simultaneous pelvic motion by monitoring the components of motion with a two-inclinometer method continuously from the initial upright posture into full flexion. All signals were sampled during real-time monitoring for off-line analyses. Back muscle activity ceased (ie, flexion relaxation [FR] occurred) at lumbar flexion with a mean of 79 degrees. Hamstring activity lasted longer and EMG activity ceased in the hamstrings when nearly full lumbar flexion (97%) was reached. After this point total flexion and pelvic flexion continued further, so that the last part of lumbar flexion and the last part of pelvic flexion happened without back muscle activity or hamstring bracing, respectively. FR of the back muscles during body flexion has been well established and its clinical significance in low back pain has been confirmed. In this study, it was shown for the first time that the hip extensors (ie, hamstring muscles) relax during forward flexion but with different timing. FR in hamstrings is not dependent on or coupled firmly with back muscle behavior in spinal disorders and the lumbar pelvic rhythm can be locally and only partially disturbed.

Relationship between the skeletal maturation of the distal attachment of the patellar tendon and physical features in preadolescent male football players.

PubMed

Nakase, Junsuke; Aiba, Tomohiro; Goshima, Kenichi; Takahashi, Ryohei; Toratani, Tatsuhiro; Kosaka, Masahiro; Ohashi, Yoshinori; Tsuchiya, Hiroyuki

2014-01-01

The aim of this study was to compare ultrasonography stages of the tibial tuberosity development and physical features. This study examined 200 knees in 100 male football players aged 10-15 years. Tibial tuberosity development on ultrasonography was divided into 3 stages: Sonolucent stage (stage S), Individual stage (stage I), and Connective stage (stage C). Age, height, quadriceps and hamstring muscle tightness, and muscle strength in knee extension and flexion were determined. These findings were compared with the respective stages of development. The tibial tuberosity was stage S in 27 knees, stage I in 69 knees, and stage C in 104 knees, with right and left sides at the same stage in 95 %. Average age and height significantly increased with advancing tibial tuberosity development. Quadriceps tightness increased with tibial tuberosity development. Hamstring tightness decreased with development. The strength of both knee extension and flexion increased with advancing development, with a greater change seen in knee extension, hamstring/quadriceps ratio: stage C, 0.74; stage A, 0.64; stage E, 0.53. Osgood-Schlatter pathogenesis reportedly involves increased quadriceps tightness with rapidly increasing femoral length during tibial tuberosity development. In this study, it was confirmed that quadriceps tightness increased, yet hamstring tightness decreased, suggesting that quadriceps tightness is not due to femoral length alone. Other factors, including muscle strength, may be involved. The study shows that thigh muscle tightness and thigh muscle performance change with the skeletal maturation of the distal attachment of the patellar tendon. These results add new information to the pathogenesis of Osgood-Schlatter disease.

A New Technique for Surgical Treatment of Proximal Hamstring Tendinopathy in a Triathlon Athlete

PubMed Central

Costa, Lincoln Paiva; Barros, Antônio Augusto Guimarães; Vassalo, Carlos Cesar; Sonnery-Cottet, Bertrand; Barbosa, Victor Atsushi Kasuya; Temponi, Eduardo Frois

2016-01-01

Introduction: Proximal hamstring tendinopathy (PHT) is the result of chronic overload caused by repetitive eccentric contraction. Surgical treatment becomes an option for patients with chronic symptoms that do not respond to conservative treatment. Case Report: This report describes a case of a 48-year-old man, an amateur triathlete, with deep gluteal pain in the left hip for 12 months, leading to a decline in sports performance. Magnetic resonance imaging revealed abnormalities that suggested a PHT. Surgery was indicated following the failure of conservative treatments. Debridement of the conjoint tendon and its reinsertion associated with semimembranosus tenotomy showed good results and is thus an option for the treatment of this pathology after 12 months of follow-up. Conclusion: This article provides surgeons with a new surgical option for this debilitating condition with clinical and functional improvement after 12 months of follow-up. PMID:28507970

Healing of donor site in bone-tendon-bone ACL reconstruction accelerated with plasma rich in growth factors: a randomized clinical trial.

PubMed

Seijas, Roberto; Rius, Marta; Ares, Oscar; García-Balletbó, Montserrat; Serra, Iván; Cugat, Ramón

2015-04-01

To determine whether the use of plasma rich in growth factors accelerates healing of the donor site in bone-tendon-bone anterior cruciate ligament (ACL) reconstruction (patellar graft). The use of the patellar graft presents post-operative problems such as anterior knee pain, which limits its use and leads to preference being taken for alternative grafts. A double-blind, randomized, clinical trial was performed comparing two groups of patients who underwent ACL reconstruction using patellar tendon graft and comparing the use of plasma rich in growth factors at the donor site after graft harvest in terms of local regeneration by ultrasound assessment. The plasma rich in growth factors group shows earlier donor site regeneration in comparison with the control group (2 months earlier), with significant differences in the first 4 months of the follow-up. The application of plasma rich in growth factors shows accelerated tissue regeneration processes with respect to the control group. This fact, together with the previously published with similar conclusions, can create a knowledge basis in order to set out new recovery guidelines following ACL reconstruction. Therapeutic study, Level I.

Physical principles demonstrate that the biceps femoris muscle relative to the other hamstring muscles exerts the most force: implications for hamstring muscle strain injuries

PubMed Central

Dolman, Bronwyn; Verrall, Geoffrey; Reid, Iain

2014-01-01

Summary Of the hamstring muscle group the biceps femoris muscle is the most commonly injured muscle in sports requiring interval sprinting. The reason for this observation is unknown. The objective of this study was to calculate the forces of all three hamstring muscles, relative to each other, during a lengthening contraction to assess for any differences that may help explain the biceps femoris predilection for injury during interval sprinting. To calculate the displacement of each individual hamstring muscle previously performed studies on cadaveric anatomical data and hamstring kinematics during sprinting were used. From these displacement calculations for each individual hamstring muscle physical principles were then used to deduce the proportion of force exerted by each individual hamstring muscle during a lengthening muscle contraction. These deductions demonstrate that the biceps femoris muscle is required to exert proportionally more force in a lengthening muscle contraction relative to the semimembranosus and semitendinosus muscles primarily as a consequence of having to lengthen over a greater distance within the same time frame. It is hypothesized that this property maybe a factor in the known observation of the increased susceptibility of the biceps femoris muscle to injury during repeated sprints where recurrent higher force is required. PMID:25506583

Different Muscle Action Training Protocols on Quadriceps-Hamstrings Neuromuscular Adaptations.

PubMed

Ruas, Cassio V; Brown, Lee E; Lima, Camila D; Gregory Haff, G; Pinto, Ronei S

2018-05-01

The aim of this study was to compare three specific concentric and eccentric muscle action training protocols on quadriceps-hamstrings neuromuscular adaptations. Forty male volunteers performed 6 weeks of training (two sessions/week) of their dominant and non-dominant legs on an isokinetic dynamometer. They were randomly assigned to one of four groups; concentric quadriceps and concentric hamstrings (CON/CON, n=10), eccentric quadriceps and eccentric hamstrings (ECC/ECC, n=10), concentric quadriceps and eccentric hamstrings (CON/ECC, n=10), or no training (CTRL, n=10). Intensity of training was increased every week by decreasing the angular velocity for concentric and increasing it for eccentric groups in 30°/s increments. Volume of training was increased by adding one set every week. Dominant leg quadriceps and hamstrings muscle thickness, muscle quality, muscle activation, muscle coactivation, and electromechanical delay were tested before and after training. Results revealed that all training groups similarly increased MT of quadriceps and hamstrings compared to control (p<0.05). However, CON/ECC and ECC/ECC training elicited a greater magnitude of change. There were no significant differences between groups for all other neuromuscular variables (p>0.05). These findings suggest that different short-term muscle action isokinetic training protocols elicit similar muscle size increases in hamstrings and quadriceps, but not for other neuromuscular variables. Nevertheless, effect sizes indicate that CON/ECC and ECC/ECC may elicit the greatest magnitude of change in muscle hypertrophy. © Georg Thieme Verlag KG Stuttgart · New York.

Articular Cartilage Increases Transition Zone Regeneration in Bone-tendon Junction Healing

PubMed Central

Qin, Ling; Lee, Kwong Man; Leung, Kwok Sui

2008-01-01

The fibrocartilage transition zone in the direct bone-tendon junction reduces stress concentration and protects the junction from failure. Unfortunately, bone-tendon junctions often heal without fibrocartilage transition zone regeneration. We hypothesized articular cartilage grafts could increase fibrocartilage transition zone regeneration. Using a goat partial patellectomy repair model, autologous articular cartilage was harvested from the excised distal third patella and interposed between the residual proximal two-thirds bone fragment and tendon during repair in 36 knees. We evaluated fibrocartilage transition zone regeneration, bone formation, and mechanical strength after repair at 6, 12, and 24 weeks and compared them with direct repair. Autologous articular cartilage interposition resulted in more fibrocartilage transition zone regeneration (69.10% ± 14.11% [mean ± standard deviation] versus 8.67% ± 7.01% at 24 weeks) than direct repair at all times. There was no difference in the amount of bone formation and mechanical strength achieved. Autologous articular cartilage interposition increases fibrocartilage transition zone regeneration in bone-tendon junction healing, but additional research is required to ascertain the mechanism of stimulation and to establish the clinical applicability. PMID:18987921

Ultrasound assessment of hamstring muscle size using posterior thigh muscle thickness.

PubMed

Abe, Takashi; Loenneke, Jeremy P; Thiebaud, Robert S

2016-05-01

Several studies have investigated the relationship between ultrasound-measured muscle thickness (MT) and individual muscle cross-sectional area (CSA) and muscle volume (MV) in extremity and trunk muscles; however, the hamstring muscle has not been studied. The purpose of this study was to examine the relationship between posterior thigh MT by ultrasound and the muscle CSA and MV of the hamstring obtained by magnetic resonance imaging (MRI). Ten young women aged 20-31 had MT measured by ultrasound at three sites on the medial anterior (50% of thigh length; TL) and posterior (50% and 70% of TL) aspects of the thigh. On the same day, a series of continuous muscle CSA along the thigh was measured by MRI. In each slice, the anatomical CSA of the hamstring (biceps femoris, semitendinosus and semimembranosus) and quadriceps muscle was analysed, and the CSAs at 50% and 70% of TL and maximal CSA of the hamstring (CSAmax ) were determined. MV was calculated by multiplying CSA by slice thickness. A significant correlation was observed between posterior 50% MT and 50% hamstring CSA (r = 0·848, P = 0·002) and between posterior 70% MT and 70% hamstring CSA (r = 0·679, P = 0·031). Posterior 50% MT (r = 0·732, P = 0·016) and 50% MTxTL (r = 0·873, P = 0·001) were also correlated to hamstring MV. Anterior:posterior 50% thigh MT ratio was correlated to MV ratio of quadriceps and hamstring muscles (r = 0·803, P = 0·005). Our results suggest that posterior thigh MT reflects hamstring muscle CSA and MV. The anterior:posterior MT ratio may serve as a surrogate for MV ratio of quadriceps and hamstring. © 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Living nanofiber yarn-based woven biotextiles for tendon tissue engineering using cell tri-culture and mechanical stimulation.

PubMed

Wu, Shaohua; Wang, Ying; Streubel, Philipp N; Duan, Bin

2017-10-15

Non-woven nanofibrous scaffolds have been developed for tendon graft application by using electrospinning strategies. However, electrospun nanofibrous scaffolds face some obstacles and limitations, including suboptimal scaffold structure, weak tensile and suture-retention strengths, and compact structure for cell infiltration. In this work, a novel nanofibrous, woven biotextile, fabricated based on electrospun nanofiber yarns, was implemented as a tissue engineered tendon scaffold. Based on our modified electrospinning setup, polycaprolactone (PCL) nanofiber yarns were fabricated with reproducible quality, and were further processed into plain-weaving fabrics interlaced with polylactic acid (PLA) multifilaments. Nonwoven nanofibrous PCL meshes with random or aligned fiber structures were generated using typical electrospinning as comparative counterparts. The woven fabrics contained 3D aligned microstructures with significantly larger pore size and obviously enhanced tensile mechanical properties than their nonwoven counterparts. The biological results revealed that cell proliferation and infiltration, along with the expression of tendon-specific genes by human adipose derived mesenchymal stem cells (HADMSC) and human tenocytes (HT), were significantly enhanced on the woven fabrics compared with those on randomly-oriented or aligned nanofiber meshes. Co-cultures of HADMSC with HT or human umbilical vein endothelial cells (HUVEC) on woven fabrics significantly upregulated the functional expression of most tenogenic markers. HADMSC/HT/HUVEC tri-culture on woven fabrics showed the highest upregulation of most tendon-associated markers than all the other mono- and co-culture groups. Furthermore, we conditioned the tri-cultured constructs with dynamic conditioning and demonstrated that dynamic stretch promoted total collagen secretion and tenogenic differentiation. Our nanofiber yarn-based biotextiles have significant potential to be used as engineered scaffolds to

Effects of Initial Graft Tension on the Tibiofemoral Compressive Forces and Joint Position Following ACL Reconstruction

PubMed Central

Brady, Mark F.; Bradley, Michael P.; Fleming, Braden C.; Fadale, Paul D.; Hulstyn, Michael J.; Banerjee, Rahul

2007-01-01

Background The initial tension applied to an ACL graft at the time of fixation modulates knee motion and the tibiofemoral compressive loads. Purpose To establish the relationships between initial graft tension, tibiofemoral compressive force, and the neutral tibiofemoral position in the cadaver knee. Study Design Controlled Laboratory Study. Methods The tibiofemoral compressive forces and joint positions were determined in the ACL-intact knee at 0°, 20° and 90° knee flexion. The ACL was excised and reconstructed with a patellar tendon graft using graft tensions of 1, 15, 30, 60 and 90 N applied at 0°, 20° and 90° knee flexion. The compressive forces and neutral positions were compared between initial tension conditions and the ACL-intact knee. Results Increasing initial graft tension increased the tibiofemoral compressive forces. The forces in the medial compartment were 1.8 times those in the lateral compartment. The compressive forces were dependent on the knee angle at which the tension was applied. The greatest compressive forces occurred when the graft was tensioned with the knee in extension. An increase in initial graft tension caused the tibia to rotate externally compared to the ACL-intact knee. Increases in initial graft tension also caused a significant posterior translation of the tibia relative to the femur. Conclusions Different initial graft tension protocols produced predictable changes in the tibiofemoral compressive forces and joint positions. Clinical Relevance The tibiofemoral compressive force and neutral joint position were best replicated with a low graft tension (1–15 N) when using a patellar tendon graft. PMID:17218659

The impact of platelet-rich plasma on the prevention of tunnel widening in anterior cruciate ligament reconstruction using quadrupled autologous hamstring tendon: a randomised clinical trial.

PubMed

Mirzatolooei, F; Alamdari, M T; Khalkhali, H R

2013-01-01

The use of platelet-rich plasma (PRP) as an adjuvant to tissue repair is gaining favour in orthopaedic surgery. Tunnel widening after anterior cruciate ligament (ACL) reconstruction is a recognised phenomenon that could compromise revision surgery. The purpose of this study was to determine whether PRP might prevent tunnel widening in ACL reconstruction.Patients undergoing ACL reconstruction using a hamstring graft were randomly allocated either to have PRP introduced into the tunnels peri-operatively or not. CT scanning of the knees was carried out on the day after surgery and at three months post-operatively and the width of the tunnels was measured. Patients were also evaluated clinically at three months, when laxity was also measured.Each group comprised 25 patients, and at three months post-operatively all were pain-free with stable knees, a negative Lachman test and a good range of movement. Arthrometric results had improved significantly in both groups (p < 0.001). Despite slightly less tunnel widening in the PRP group, there was no significant difference between the groups at the femoral opening or the mid-tunnel (p = 0.370 and p = 0.363, respectively) nor at the tibial opening or mid-tunnel (p = 0.333 and p = 0.177, respectively).We conclude that PRP has no significant effect in preventing tunnel widening after ACL reconstruction.

Novel engineered tendon-fibrocartilage-bone composite with cyclic tension for rotator cuff repair.

PubMed

Liu, Qian; Hatta, Taku; Qi, Jun; Liu, Haoyu; Thoreson, Andrew R; Amadio, Peter C; Moran, Steven L; Steinmann, Scott P; Gingery, Anne; Zhao, Chunfeng

2018-05-15

Surgical repair of rotator cuff tears presents a significant clinical challenge with high failure rates and inferior functional outcomes. Graft augmentation improves repair outcomes, however currently available grafting materials have limitations. While cell-seeded decellularized tendon slices may facilitate cell infiltration, promote tendon incorporation and preserve original mechanical strength, the unique fibrocartilage zone is yet to be successfully reestablished. In this study, we investigated the biological and mechanical properties of an engineered tendon-fibrocartilage-bone composite (TFBC) with cyclic tension (3% strain, 0.2 Hz). Decellularized TFBCs seeded with bone marrow-derived mesenchymal stem cell (BMSCs) sheets and subjected to mechanical stimulation for up to 7 days, were characterized by histology, immunohistochemistry, scanning electron microscopy, mechanical testing, and transcriptional regulation. The decellularized TFBC maintained native enthesis structure and properties. Mechanically stimulated TFBC-BMSC constructs displayed increased cell migration after 7 days of culture compared to static groups. The seeded cell sheet not only integrated well with tendon scaffold but also distributed homogeneously and aligned to the direction of stretch under dynamic culture. Developmental genes were regulated including, scleraxis which was significantly upregulated with mechanical stimulation. The Young's modulus of the cell-seeded constructs was significantly higher compared to the non-cell-seeded controls. In conclusion, the results of this study reveal that the TFBC-BMSC composite provides an ideal multilayer construct for cell seeding and growth, with mechanical preconditioning further enhances cell penetration and differentiation. The BMSC cell sheet revitalized TFBC in conjunction with mechanical stimulation could serve as a novel and primed biological patch to improve rotator cuff repair. This article is protected by copyright. All rights reserved.

Variations in medial-lateral hamstring force and force ratio influence tibiofemoral kinematics.

PubMed

Shalhoub, Sami; Fitzwater, Fallon G; Cyr, Adam J; Maletsky, Lorin P

2016-10-01

A change in hamstring strength and activation is typically seen after injuries or invasive surgeries such as anterior cruciate reconstruction or total knee replacement. While many studies have investigated the influence of isometric increases in hamstring load on knee joint kinematics, few have quantified the change in kinematics due to a variation in medial to lateral hamstring force ratio. This study examined the changes in knee joint kinematics on eight cadaveric knees during an open-chain deep knee bend for six different loading configurations: five loaded hamstring configurations that varied the ratio of a total load of 175 N between the semimembranosus and biceps femoris and one with no loads on the hamstring. The anterior-posterior translation of the medial and lateral femoral condyles' lowest points along proximal-distal axis of the tibia, the axial rotation of the tibia, and the quadriceps load were measured at each flexion angle. Unloading the hamstring shifted the medial and lateral lowest points posteriorly and increased tibial internal rotation. The influence of unloading hamstrings on quadriceps load was small in early flexion and increased with knee flexion. The loading configuration with the highest lateral hamstrings force resulted in the most posterior translation of the medial lowest point, most anterior translation of the lateral lowest point, and the highest tibial external rotation of the five loading configurations. As the medial hamstring force ratio increased, the medial lowest point shifted anteriorly, the lateral lowest point shifted posteriorly, and the tibia rotated more internally. The results of this study, demonstrate that variation in medial-lateral hamstrings force and force ratio influence tibiofemoral transverse kinematics and quadriceps loads required to extend the knee. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1707-1715, 2016. © 2016 Orthopaedic Research Society. Published by

Knee Moment-Angle Characteristics and Semitendinosus Muscle Morphology in Children with Spastic Paresis Selected for Medial Hamstring Lengthening

PubMed Central

Haberfehlner, Helga; Jaspers, Richard T.; Rutz, Erich; Becher, Jules G.; Harlaar, Jaap; van der Sluijs, Johannes A.; Witbreuk, Melinda M.; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald

2016-01-01

To increase knee range of motion and improve gait in children with spastic paresis (SP), the semitendinosus muscle (ST) amongst other hamstring muscles is frequently lengthened by surgery, but with variable success. Little is known about how the pre-surgical mechanical and morphological characteristics of ST muscle differ between children with SP and typically developing children (TD). The aims of this study were to assess (1) how knee moment-angle characteristics and ST morphology in children with SP selected for medial hamstring lengthening differ from TD children, as well as (2) how knee moment-angle characteristics and ST morphology are related. In nine SP and nine TD children, passive knee moment-angle characteristics and morphology of ST (i.e. fascicle length, muscle belly length, tendon length, physiological cross-sectional area, and volume) were assessed by hand-held dynamometry and freehand 3D ultrasound, respectively. At net knee flexion moments above 0.5 Nm, more flexed knee angles were found for SP compared to TD children. The measured knee angle range between 0 and 4 Nm was 30% smaller in children with SP. Muscle volume, physiological cross-sectional area, and fascicle length normalized to femur length were smaller in SP compared to TD children (62%, 48%, and 18%, respectively). Sixty percent of the variation in knee angles at 4 Nm net knee moment was explained by ST fascicle length. Altered knee moment-angle characteristics indicate an increased ST stiffness in SP children. Morphological observations indicate that in SP children planned for medial hamstring lengthening, the longitudinal and cross-sectional growth of ST muscle fibers is reduced. The reduced fascicle length can partly explain the increased ST stiffness and, hence, a more flexed knee joint in these SP children. PMID:27861523

Knee Moment-Angle Characteristics and Semitendinosus Muscle Morphology in Children with Spastic Paresis Selected for Medial Hamstring Lengthening.

PubMed

Haberfehlner, Helga; Jaspers, Richard T; Rutz, Erich; Becher, Jules G; Harlaar, Jaap; van der Sluijs, Johannes A; Witbreuk, Melinda M; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald; Maas, Huub; Buizer, Annemieke I

2016-01-01

To increase knee range of motion and improve gait in children with spastic paresis (SP), the semitendinosus muscle (ST) amongst other hamstring muscles is frequently lengthened by surgery, but with variable success. Little is known about how the pre-surgical mechanical and morphological characteristics of ST muscle differ between children with SP and typically developing children (TD). The aims of this study were to assess (1) how knee moment-angle characteristics and ST morphology in children with SP selected for medial hamstring lengthening differ from TD children, as well as (2) how knee moment-angle characteristics and ST morphology are related. In nine SP and nine TD children, passive knee moment-angle characteristics and morphology of ST (i.e. fascicle length, muscle belly length, tendon length, physiological cross-sectional area, and volume) were assessed by hand-held dynamometry and freehand 3D ultrasound, respectively. At net knee flexion moments above 0.5 Nm, more flexed knee angles were found for SP compared to TD children. The measured knee angle range between 0 and 4 Nm was 30% smaller in children with SP. Muscle volume, physiological cross-sectional area, and fascicle length normalized to femur length were smaller in SP compared to TD children (62%, 48%, and 18%, respectively). Sixty percent of the variation in knee angles at 4 Nm net knee moment was explained by ST fascicle length. Altered knee moment-angle characteristics indicate an increased ST stiffness in SP children. Morphological observations indicate that in SP children planned for medial hamstring lengthening, the longitudinal and cross-sectional growth of ST muscle fibers is reduced. The reduced fascicle length can partly explain the increased ST stiffness and, hence, a more flexed knee joint in these SP children.

A Canine Arthroscopic Anterior Cruciate Ligament Reconstruction Model for Study of Synthetic Augmentation of Tendon Allografts.

PubMed

Cook, James L; Smith, Pat; Stannard, James P; Pfeiffer, Ferris; Kuroki, Keiichi; Bozynski, Chantelle C; Cook, Cristi

2017-09-01

Novel graft types, fixation methods, and means for augmenting anterior cruciate ligament (ACL) reconstructions require preclinical validation prior to safe and effective clinical application. The objective of this study was to describe and validate a translational canine model for all-inside arthroscopic complete ACL reconstruction using a quadriceps tendon allograft with internal brace (QTIB). With institutional approval, adult research hounds underwent complete transection of the native ACL followed by all-inside ACL reconstruction using the novel QTIB construct with suspensory fixation ( n  = 10). Contralateral knees were used as nonoperated controls ( n  = 10). Dogs were assessed over a 6-month period using functional, diagnostic imaging, gross, biomechanical, and histologic outcome measures required for preclinical animal models. Study results suggest that the novel QTIB construct used for complete ACL reconstruction can provide sustained knee stability and function without the development of premature osteoarthritis in a rigorous and valid preclinical model. The unique configuration of the QTIB construct-the combination of a tendon allograft with a synthetic suture tape internal brace-allowed for an effective biologic-synthetic load-sharing ACL construct. It prevented early failure, allowed for direct, four-zone graft-to-bone healing, and functional graft remodeling while avoiding problems noted with use of all-synthetic grafts. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Immediate and Delayed High-Strain Loading on Tendon-to-Bone Healing After Anterior Cruciate Ligament Reconstruction

PubMed Central

Packer, Jonathan D.; Bedi, Asheesh; Fox, Alice J.; Gasinu, Selom; Imhauser, Carl W.; Stasiak, Mark; Deng, Xiang-Hua; Rodeo, Scott A.

2014-01-01

Background: We previously demonstrated, in a rat anterior cruciate ligament (ACL) graft reconstruction model, that the delayed application of low-magnitude-strain loading resulted in improved tendon-to-bone healing compared with that observed after immediate loading and after prolonged immobilization. The purpose of this study was to determine the effect of higher levels of strain loading on tendon-to-bone healing. Methods: ACL reconstruction was carried out in a rat model in three randomly assigned groups: high-strain daily loading beginning on either (1) postoperative day one (immediate-loading group; n = 7) or (2) postoperative day four (delayed-loading group; n = 11) or (3) after prolonged immobilization (immobilized group; n = 8). Animals were killed two weeks after surgery and micro-computed tomography (micro-CT) and biomechanical testing of the bone-tendon-bone complex were carried out. Results: The delayed-loading group had greater tissue mineral density than either the immediate-loading or immobilized group (mean [and standard deviation], 813.0 ± 24.9 mg/mL compared with 778.4 ± 32.6 mg/mL and 784.9 ± 26.4 mg/mL, respectively; p < 0.05). There was a trend toward greater bone volume per total volume fraction in both the immobilized and the delayed-loading group compared with the immediate-loading group (0.24 ± 0.03 and 0.23 ± 0.06 compared with 0.20 ± 0.05; p = 0.06). Trabecular thickness was greater in the immobilized group compared with the immediate-loading group (106.5 ± 23.0 μm compared with 72.6 ± 10.6 μm; p < 0.01). There were no significant differences in failure load or stiffness between the immobilized group and either high-strain cyclic-loading group. Conclusions: Immediate application of high-strain loading appears to have a detrimental effect on healing in this rat model. Any beneficial effects of delayed loading on the healing tendon-bone interface (after a brief period of immobilization) may be offset by the detrimental effects of

Hamstring Injuries in Professional Football Players

PubMed Central

Cohen, Steven B.; Towers, Jeffrey D.; Zoga, Adam; Irrgang, Jay J.; Makda, Junaid; Deluca, Peter F.; Bradley, James P.

2011-01-01

Background: Magnetic resonance imaging (MRI) allows for detailed evaluation of hamstring injuries; however, there is no classification that allows prediction of return to play. Purpose: To correlate time for return to play in professional football players with MRI findings after acute hamstring strains and to create an MRI scoring scale predictive of return to sports. Study Design: Descriptive epidemiologic study. Methods: Thirty-eight professional football players (43 cases) sustained acute hamstring strains with MRI evaluation. Records were retrospectively reviewed, and MRIs were evaluated by 2 musculoskeletal radiologists, graded with a traditional radiologic grade, and scored with a new MRI score. Results were correlated with games missed. Results: Players missed 2.6 ± 3.1 games. Based on MRI, the hamstring injury involved the biceps femoris long head in 34 cases and the proximal and distal hamstrings in 25 and 22 cases, respectively. When < 50% of the muscle was involved, the average number of games missed was 1.8; if > 75%, then 3.2. Ten players had retraction, missing 5.5 games. By MRI, grade I injuries yielded an average of 1.1 missed games; grade II, 1.7; and grade III, 6.4. Players who missed 0 or 1 game had an MRI score of 8.2; 2 or 3 games, 11.1; and 4 or more games, 13.9. Conclusions: Rapid return to play (< 1 week) occurred with isolated long head of biceps femoris injures with < 50% of involvement and minimal perimuscular edema, correlating to grade I radiologic strain (MRI score < 10). Prolonged recovery (missing > 2 or 3 games) occurs with multiple muscle injury, injuries distal to musculotendinous junction, short head of biceps injury, > 75% involvement, retraction, circumferential edema, and grade III radiologic strain (MRI score > 15). Clinical Relevance: MRI grade and this new MRI score are useful in determining severity of injury and games missed—and, ideally, predicting time missed from sports. PMID:23016038

Contribution of hamstring fatigue to quadriceps inhibition following lumbar extension exercise.

PubMed

Hart, Joseph M; Kerrigan, D Casey; Fritz, Julie M; Saliba, Ethan N; Gansneder, Bruce; Ingersoll, Christopher D

2006-01-01

The purpose of this study was to determine the contribution of hamstrings and quadriceps fatigue to quadriceps inhibition following lumbar extension exercise. Regression models were calculated consisting of the outcome variable: quadriceps inhibition and predictor variables: change in EMG median frequency in the quadriceps and hamstrings during lumbar fatiguing exercise. Twenty-five subjects with a history of low back pain were matched by gender, height and mass to 25 healthy controls. Subjects performed two sets of fatiguing isometric lumbar extension exercise until mild (set 1) and moderate (set 2) fatigue of the lumbar paraspinals. Quadriceps and hamstring EMG median frequency were measured while subjects performed fatiguing exercise. A burst of electrical stimuli was superimposed while subjects performed an isometric maximal quadriceps contraction to estimate quadriceps inhibition after each exercise set. Results indicate the change in hamstring median frequency explained variance in quadriceps inhibition following the exercise sets in the history of low back pain group only. Change in quadriceps median frequency explained variance in quadriceps inhibition following the first exercise set in the control group only. In conclusion, persons with a history of low back pain whose quadriceps become inhibited following lumbar paraspinal exercise may be adapting to the fatigue by using their hamstring muscles more than controls. Key PointsA neuromuscular relationship between the lumbar paraspinals and quadriceps while performing lumbar extension exercise may be influenced by hamstring muscle fatigue.QI following lumbar extension exercise in persons with a history of LBP group may involve significant contribution from the hamstring muscle group.More hamstring muscle contribution may be a necessary adaptation in the history of LBP group due to weaker and more fatigable lumbar extensors.

Relationship between hamstring length and gluteus maximus strength with and without normalization.

PubMed

Lee, Dong-Kyu; Oh, Jae-Seop

2018-01-01

[Purpose] This study assessed the relationship between hamstring length and gluteus maximus (GM) strength with and without normalization by body weight and height. [Subjects and Methods] In total, 34 healthy male subjects volunteered for this study. To measure GM strength, subjects performed maximal hip joint extension with the knee joints flexed to 90° in the prone position. GM strength was normalized for body weight and height. [Results] GM strength with normalization was positively correlated with hamstring length, whereas GM strength without normalization was negatively correlated with hamstring length. [Conclusion] The normalization of GM strength by body weight and height has the potential to lead to more appropriate conclusions and interpretations about its correlation with hamstring length. Hamstring length may be related to GM strength.

Graft Diameter as a Predictor for Revision Anterior Cruciate Ligament Reconstruction and KOOS and EQ-5D Values: A Cohort Study From the Swedish National Knee Ligament Register Based on 2240 Patients.

PubMed

Snaebjörnsson, Thorkell; Hamrin Senorski, Eric; Ayeni, Olufemi R; Alentorn-Geli, Eduard; Krupic, Ferid; Norberg, Fredrik; Karlsson, Jón; Samuelsson, Kristian

2017-07-01

Anterior cruciate ligament (ACL) reconstruction (ACLR) using a hamstring tendon (HT) autograft is an effective and widespread method. Recent studies have identified a relationship between the graft diameter and revision ACLR. To evaluate the influence of the graft diameter on revision ACLR and patient-reported outcomes in patients undergoing primary ACLR using HT autografts. Cohort study; Level of evidence, 2. A prospective cohort study was conducted using the Swedish National Knee Ligament Register (SNKLR) involving all patients undergoing primary ACLR using HT autografts. Patients with graft failure who needed revision surgery (cases) were compared with patients not undergoing revision surgery (controls). The control group was matched for sex, age, and graft fixation method in a 3:1 ratio. Conditional logistic regression was performed to produce odds ratios and 95% CIs. Univariate linear regression analyses were performed for patient-related outcomes. The Knee injury and Osteoarthritis Outcome Score (KOOS) and EuroQol 5 dimensions questionnaire (EQ-5D) values were obtained. A total of 2240 patients were included in which there were 560 cases and 1680 controls. No significant differences between the cases and controls were found for sex (52.9% male), mean age (21.7 years), and femoral and tibial fixation. The mean graft diameter for the cases was 8.0 ± 0.74 mm and for the controls was 8.1 ± 0.76 mm. In the present cohort, the likelihood of revision surgery for every 0.5-mm increase in the HT autograft diameter between 7.0 and 10.0 mm was 0.86 (95% CI, 0.75-0.99; P = .03). Univariate linear regression analysis found no significant regression coefficient for the change in KOOS or EQ-5D values. In a large cohort of patients after primary ACLR with HT autografts, an increase in the graft diameter between 7.0 and 10.0 mm resulted in a 0.86 times lower likelihood of revision surgery with every 0.5-mm increase. This study provides further evidence of the importance of

Comparison of gluteal and hamstring activation during five commonly used plyometric exercises.

PubMed

Struminger, Aaron H; Lewek, Michael D; Goto, Shiho; Hibberd, Elizabeth; Blackburn, J Troy

2013-08-01

Anterior cruciate ligament injuries occur frequently in athletics, and anterior cruciate ligament injury prevention programs may decrease injury risk. However, previous prevention programs that include plyometrics use a variety of exercises with little justification of exercise inclusion. Because gluteal and hamstring activation is thought to be important for preventing knee injuries, the purpose of this study was to determine which commonly used plyometric exercises produce the greatest activation of the gluteals and hamstrings. EMG (Electromyography) amplitudes of the hamstring and gluteal muscles during preparatory and loading phases of landing were recorded in 41 subjects during 5 commonly used plyometric exercises. Repeated measures ANOVAs (Analysis of Variance) were used on 36 subjects to examine differences in muscle activation. Differences in hamstring (P<.01) and gluteal (P<.01) activities were identified across exercises during the preparatory and landing phases. The single-leg sagittal plane hurdle hops produced the greatest gluteal and hamstring activity in both phases. The 180° jumps did not produce significantly greater gluteal or hamstring activity than any other exercise. Single-leg sagittal plane hurdle hops may be the most effective exercise to activate the gluteals and hamstrings and may be important to include in anterior cruciate ligament injury prevention programs, given the importance of these muscles for limiting valgus loading of the knee. Because 180° jumps do not produce greater gluteal and hamstring activation than other plyometric exercises, their removal from injury prevention programs may be warranted without affecting program efficacy. © 2013.

Peroneal perforator-based peroneus longus tendon and sural neurofasciocutaneous composite flap transfer for a large soft-tissue defect of the forearm: A case report.

PubMed

Hayashida, Kenji; Saijo, Hiroto; Fujioka, Masaki

2018-01-01

We describe the use of a composite flap composed of a sural neurofasciocutaneous flap and a vascularized peroneus longus tendon for the reconstruction of severe composite forearm tissue defects in a patient. A 43-year-old man had his left arm caught in a conveyor belt resulting in a large soft-tissue defect of 18 × 11 cm over the dorsum forearm. The extensor carpi radialis, superficial radial nerve, and radial artery were severely damaged. A free neurofasciocutaneous composite flap measuring 16 × 11 cm was outlined on the patient's left lower leg to allow simultaneous skin, tendon, nerve, and artery reconstruction. The flap, which included the peroneus longus tendon, was elevated on the subfascial plane. After the flap was transferred to the recipient site, the peroneal artery was anastomosed to the radial artery in a flow-through manner. The vascularized tendon graft with 15 cm in length was used to reconstruct the extensor carpi radialis longus tendon defect using an interlacing suture technique. As the skin paddle of the sural neurofasciocutaneous flap and the vascularized peroneus longus tendon graft were linked by the perforator and minimal fascial tissue, the skin paddle was able to rotate and slide with comparative ease. The flap survived completely without any complications. The length of follow-up was 12 months and was uneventful. Range of motion of his left wrist joint was slightly limited to 75 degrees. This novel composite flap may be useful for reconstructing long tendon defects associated with extensive forearm soft tissue defects. © 2016 Wiley Periodicals, Inc.

Bone morphogenetic protein 7 (BMP-7) influences tendon-bone integration in vitro.

PubMed

Schwarting, Tim; Lechler, Philipp; Struewer, Johannes; Ambrock, Marius; Frangen, Thomas Manfred; Ruchholtz, Steffen; Ziring, Ewgeni; Frink, Michael

2015-01-01

Successful graft ingrowth following reconstruction of the anterior cruciate ligament is governed by complex biological processes at the tendon-bone interface. The aim of this study was to investigate in an in vitro study the effects of bone morphogenetic protein 7 (BMP-7) on tendon-bone integration. To study the biological effects of BMP-7 on the process of tendon-bone-integration, two independent in vitro models were used. The first model involved the mono- and coculture of bovine tendon specimens and primary bovine osteoblasts with and without BMP-7 exposure. The second model comprised the mono- and coculture of primary bovine osteoblasts and fibroblasts. Alkaline phosphatase (ALP), lactate dehydrogenase (LDH), lactate and osteocalcin (OCN) were analyzed by ELISA. Histological analysis and electron microscopy of the tendon specimens were performed. In both models, positive effects of BMP-7 on ALP enzyme activity were observed (p<0.001). Additionally, similar results were noted for LDH activity and lactate concentration. BMP-7 stimulation led to a significant increase in OCN expression. Whereas the effects of BMP-7 on tendon monoculture peaked during an early phase of the experiment (p<0.001), the cocultures showed a maximal increase during the later stages (p<0.001). The histological analysis showed a stimulating effect of BMP-7 on extracellular matrix formation. Organized ossification zones and calcium carbonate-like structures were only observed in the BMP-stimulated cell cultures. This study showed the positive effects of BMP-7 on the biological process of tendon-bone integration in vitro. Histological signs of improved mineralization were paralleled by increased rates of osteoblast-specific protein levels in primary bovine osteoblasts and fibroblasts. Our findings indicated a role for BMP-7 as an adjuvant therapeutic agent in the treatment of ligamentous injuries, and they emphasized the importance of the transdifferentiation process of tendinous fibroblasts

An Evidence-Based Framework for Strengthening Exercises to Prevent Hamstring Injury.

PubMed

Bourne, Matthew N; Timmins, Ryan G; Opar, David A; Pizzari, Tania; Ruddy, Joshua D; Sims, Casey; Williams, Morgan D; Shield, Anthony J

2018-02-01

Strength training is a valuable component of hamstring strain injury prevention programmes; however, in recent years a significant body of work has emerged to suggest that the acute responses and chronic adaptations to training with different exercises are heterogeneous. Unfortunately, these research findings do not appear to have uniformly influenced clinical guidelines for exercise selection in hamstring injury prevention or rehabilitation programmes. The purpose of this review was to provide the practitioner with an evidence-base from which to prescribe strengthening exercises to mitigate the risk of hamstring injury. Several studies have established that eccentric knee flexor conditioning reduces the risk of hamstring strain injury when compliance is adequate. The benefits of this type of training are likely to be at least partly mediated by increases in biceps femoris long head fascicle length and improvements in eccentric knee flexor strength. Therefore, selecting exercises with a proven benefit on these variables should form the basis of effective injury prevention protocols. In addition, a growing body of work suggests that the patterns of hamstring muscle activation diverge significantly between different exercises. Typically, relatively higher levels of biceps femoris long head and semimembranosus activity have been observed during hip extension-oriented movements, whereas preferential semitendinosus and biceps femoris short head activation have been reported during knee flexion-oriented movements. These findings may have implications for targeting specific muscles in injury prevention programmes. An evidence-based approach to strength training for the prevention of hamstring strain injury should consider the impact of exercise selection on muscle activation, and the effect of training interventions on hamstring muscle architecture, morphology and function. Most importantly, practitioners should consider the effect of a strength training programme on

Transcription factor EGR1 directs tendon differentiation and promotes tendon repair

PubMed Central

Guerquin, Marie-Justine; Charvet, Benjamin; Nourissat, Geoffroy; Havis, Emmanuelle; Ronsin, Olivier; Bonnin, Marie-Ange; Ruggiu, Mathilde; Olivera-Martinez, Isabel; Robert, Nicolas; Lu, Yinhui; Kadler, Karl E.; Baumberger, Tristan; Doursounian, Levon; Berenbaum, Francis; Duprez, Delphine

2013-01-01

Tendon formation and repair rely on specific combinations of transcription factors, growth factors, and mechanical parameters that regulate the production and spatial organization of type I collagen. Here, we investigated the function of the zinc finger transcription factor EGR1 in tendon formation, healing, and repair using rodent animal models and mesenchymal stem cells (MSCs). Adult tendons of Egr1–/– mice displayed a deficiency in the expression of tendon genes, including Scx, Col1a1, and Col1a2, and were mechanically weaker compared with their WT littermates. EGR1 was recruited to the Col1a1 and Col2a1 promoters in postnatal mouse tendons in vivo. Egr1 was required for the normal gene response following tendon injury in a mouse model of Achilles tendon healing. Forced Egr1 expression programmed MSCs toward the tendon lineage and promoted the formation of in vitro–engineered tendons from MSCs. The application of EGR1-producing MSCs increased the formation of tendon-like tissues in a rat model of Achilles tendon injury. We provide evidence that the ability of EGR1 to promote tendon differentiation is partially mediated by TGF-β2. This study demonstrates EGR1 involvement in adult tendon formation, healing, and repair and identifies Egr1 as a putative target in tendon repair strategies. PMID:23863709

Fluoroscopically Guided Peritendinous Corticosteroid Injection for Proximal Hamstring Tendinopathy: A Retrospective Review.

PubMed

Nicholson, Luke T; DiSegna, Steven; Newman, Joel S; Miller, Suzanne L

2014-03-01

Proximal hamstring tendinopathy is an uncommon but debilitating cause of posterior thigh pain in athletes subjected to repetitive eccentric hamstring contraction, such as runners. Minimal data exist evaluating treatment options for proximal hamstring tendinopathy. This retrospective study evaluates the effectiveness of fluoroscopically guided corticosteroid injections in treating proximal hamstring tendinopathy. Case series; Level of evidence, 4. Eighteen athletes with 22 cases of magnetic resonance imaging-confirmed proximal hamstring tendinopathy were treated with corticosteroid injection and later contacted to evaluate the efficacy of the injection with the use of a questionnaire. The visual analog score decreased from 7.22 preinjection to 3.94 postinjection (P < .001), level of athletic participation increased from 28.76% to 68.82% (P < .001) at a mean follow-up of 21 months, and 38.8% of patients experienced complete resolution at a mean follow-up of 24.8 months. The mean lower extremity function score at the time of follow-up was 60. A trial of fluoroscopically guided corticosteroid injection is warranted in patients presenting with symptoms of proximal hamstring tendinopathy refractory to conservative therapy.

The predictive validity of a single leg bridge test for hamstring injuries in Australian Rules Football Players.

PubMed

Freckleton, Grant; Cook, Jill; Pizzari, Tania

2014-04-01

Hamstring muscle strain injuries (HMSI) are the greatest injury problem in kicking sports such as Australian Rules Football. Reduced hamstring muscle strength is commonly perceived to be a risk factor for hamstring injury; however, evidence is inconclusive. Testing hamstring strength with the hip and knee at functional angles and assessing endurance parameters may be more relevant for examining the risk of hamstring injury. The primary aim of this prospective study was to examine if reduced hamstring muscle strength assessed with the single leg hamstring bridge (SLHB) was a risk factor for hamstring injury. Hamstring muscle strength of 482 amateur and semielite players from 16 football clubs, mean age 20.7 (range 16-34 years), was tested during the 2011 preseason. Players were then monitored throughout the 2011 playing season for HMSI. A total of 28 hamstring injuries, 16 right and 12 left, were recorded. Players who sustained a right HMSI during the season had a significantly lower mean right SLHB score (p=0.029), were older (p=0.002) and were more likely to have sustained a past right hamstring injury (p=0.02) or right knee injury (p=0.035). For left-sided hamstring injury, the injured group was more likely to be left leg dominant (p=0.001), older athletes (p=0.002) and there was a trend towards a history of left hamstring injury (p=0.07). This study demonstrated a significant deficit in preseason SLHB scores on the right leg of players that subsequently sustained a right-sided hamstring injury. Age, previous knee injury and a history of hamstring injury were other risk factors supported in this study. Low hamstring strength appears to be a risk factor for hamstring injury; however, due to the confounding variables and low injury rate in this study, further studies are required.

The effect of Nordic hamstring strength training on muscle architecture, stiffness, and strength.

PubMed

Seymore, Kayla D; Domire, Zachary J; DeVita, Paul; Rider, Patrick M; Kulas, Anthony S

2017-05-01

Hamstring strain injury is a frequent and serious injury in competitive and recreational sports. While Nordic hamstring (NH) eccentric strength training is an effective hamstring injury-prevention method, the protective mechanism of this exercise is not understood. Strength training increases muscle strength, but also alters muscle architecture and stiffness; all three factors may be associated with reducing muscle injuries. The purpose of this study was to examine the effects of NH eccentric strength training on hamstring muscle architecture, stiffness, and strength. Twenty healthy participants were randomly assigned to an eccentric training group or control group. Control participants performed static stretching, while experimental participants performed static stretching and NH training for 6 weeks. Pre- and post-intervention measurements included: hamstring muscle architecture and stiffness using ultrasound imaging and elastography, and maximal hamstring strength measured on a dynamometer. The experimental group, but not the control group, increased volume (131.5 vs. 145.2 cm 3 , p < 0.001) and physiological cross-sectional area (16.1 vs. 18.1 cm 2 , p = 0.032). There were no significant changes to muscle fascicle length, stiffness, or eccentric hamstring strength. The NH intervention was an effective training method for muscle hypertrophy, but, contrary to common literature findings for other modes of eccentric training, did not increase fascicle length. The data suggest that the mechanism behind NH eccentric strength training mitigating hamstring injury risk could be increasing volume rather than increasing muscle length. Future research is, therefore, warranted to determine if muscle hypertrophy induced by NH training lowers future hamstring strain injury risk.

Muscle activation patterns in the Nordic hamstring exercise: Impact of prior strain injury.

PubMed

Bourne, M N; Opar, D A; Williams, M D; Al Najjar, A; Shield, A J

2016-06-01

This study aimed to determine: (a) the spatial patterns of hamstring activation during the Nordic hamstring exercise (NHE); (b) whether previously injured hamstrings display activation deficits during the NHE; and (c) whether previously injured hamstrings exhibit altered cross-sectional area (CSA). Ten healthy, recreationally active men with a history of unilateral hamstring strain injury underwent functional magnetic resonance imaging of their thighs before and after six sets of 10 repetitions of the NHE. Transverse (T2) relaxation times of all hamstring muscles [biceps femoris long head (BFlh); biceps femoris short head (BFsh); semitendinosus (ST); semimembranosus (SM)] were measured at rest and immediately after the NHE and CSA was measured at rest. For the uninjured limb, the ST's percentage increase in T2 with exercise was 16.8%, 15.8%, and 20.2% greater than the increases exhibited by the BFlh, BFsh, and SM, respectively (P < 0.002 for all). Previously injured hamstring muscles (n = 10) displayed significantly smaller increases in T2 post-exercise than the homonymous muscles in the uninjured contralateral limb (mean difference -7.2%, P = 0.001). No muscles displayed significant between-limb differences in CSA. During the NHE, the ST is preferentially activated and previously injured hamstring muscles display chronic activation deficits compared with uninjured contralateral muscles. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: a randomized, controlled clinical study.

PubMed

Cervellin, M; de Girolamo, L; Bait, C; Denti, M; Volpi, P

2012-01-01

Bone-patellar tendon-bone technique (BPTB) for anterior cruciate ligament injuries is associated with a higher risk of donor-site morbidity. To evaluate whether platelet-rich plasma (PRP), due to its anti-inflammatory properties and capacity to stimulate tissue regeneration, was able to reduce the anterior knee pain, the kneeling pain, and donor-site morbidity, as evidenced by evaluation of VISA and VAS scoring scales and MRI analysis of the tendon and bone defect, we performed a clinical randomized controlled study where PRP gel was applied to donor site after ACL reconstruction with BPTB. Forty young athletes with the indication of ACL reconstruction with patellar tendon grafts were randomly assigned to group A (n = 20 patients, control group) or group B (n = 20 patients, PRP group). The autologous PRP gel was applied to both the patellar and tendon bone plug harvest site and stabilized by the peritenon suture. At 12-month follow-up, all patients underwent clinical examination and VAS and VISA questionnaires, respectively, evaluating the average daily pain of the knee and the pain during particular activities involving the knee, were filled. MRI at the same time point was also performed. VISA scores were significantly higher in the patients treated with PRP (84.5 ± 11.8 and 97.8 ± 2.5 for group A and for group B; P = 0.041), whereas no significant difference in postoperative VAS scores between the two groups was observed (1 ± 1.4 and 0.6 ± 0.9 for group A and group B, n.s.). In 85% of PRP group patients, the tibial and patellar bone defect was satisfactorily filled by new bony tissue (>70% of bone gap filled), whereas this percentage was just of 60% in control group patients, but this difference was not statistically significant. The study shows the usefulness of PRP in reducing subjective pain at the donor-site level after ACL reconstruction with BPTB. However, this approach deserves further investigations to confirm PRP efficacy and to

Extensibility and stiffness of the hamstrings in patients with nonspecific low back pain.

PubMed

Halbertsma, J P; Göeken, L N; Hof, A L; Groothoff, J W; Eisma, W H

2001-02-01

To investigate the extensibility and stiffness of the hamstrings in patients with nonspecific low back pain (LBP). An experimental design. A university laboratory for human movement analysis in a department of rehabilitation medicine. Forty subjects, a patient group (20) and a healthy control group (20). Subjects laid supine on an examination table with a lift frame, with left leg placed in a sling at the ankle. Straight leg raising, pulling force, and activity of hamstring and back muscles were recorded with electrodes. Patients indicated when they experienced tension or pain. The lift force, leg excursion, pelvic-femoral angle, first sensation of pain, and the electromyogram of the hamstrings and back muscles measured in an experimental straight-leg raising set-up. The patient group showed a significant restriction in range of motion (ROM) and extensibility of the hamstrings compared with the control group. No significant difference in hamstring muscle stiffness can be assessed between both groups. The restricted ROM and the decreased extensibility of the hamstrings in patients with nonspecific LBP is not caused by increased muscle stiffness of the hamstrings, but determined by the stretch tolerance of the patients.

Single-Stage Reconstruction of Achilles Tendon and Overlying Tissue With the Extended Temporoparietal Fasciagaleal Flap--23-Year Follow-Up and the Review of the Literature.

PubMed

Dobke, Marek; Suliman, Ahmed; Mackert, Gina A; Herrera, Fernando A; Singer, Robert; Nelson, Jeffrey

2016-05-01

In the absence of an established "gold standard" for complex Achilles tendon and regional soft tissue defect reconstruction, many techniques have been advocated. Two cases describing a novel technique of successful repair with the review of literature are presented. The underlying problem consisted of Achilles tendon necrosis with local inflammation in the first case and tendon contracture with foot malposition due to a burn injury in the other. Each patient, upon debridement, had a 6-cm Achilles tendon defect with associated overlying soft tissue deficits reconstructed with an extended temporoparietal fasciagaleal flap and a split thickness skin graft. Both cases highlight the successful functional and aesthetic quality as well as the durability of concurrent vascularized tendon and soft tissue replacement and coverage in 2 distinct clinical scenarios.

Coverage of Deep Cutaneous Wounds Using Dermal Template in Combination with Negative-pressure Therapy and Subsequent Skin Graft

PubMed Central

Chang, Alexandre A.; Lobato, Rodolfo C.; Nakamoto, Hugo A.; Tuma, Paulo; Ferreira, Marcus C.

2014-01-01

Background: We consider the use of dermal matrix associated with a skin graft to cover deep wounds in the extremities when tendon and bone are exposed. The objective of this article was to evaluate the efficacy of covering acute deep wounds through the use of a dermal regeneration template (Integra) associated with vacuum therapy and subsequent skin grafting. Methods: Twenty patients were evaluated prospectively. All of them had acute (up to 3 weeks) deep wounds in the limbs. We consider a deep wound to be that with exposure of bone, tendon, or joint. Results: The average area of integration of the dermal regeneration template was 86.5%. There was complete integration of the skin graft over the dermal matrix in 14 patients (70%), partial integration in 5 patients (25%), and total loss in 1 case (5%). The wound has completely closed in 95% of patients. Conclusions: The use of Integra dermal template associated with negative-pressure therapy and skin grafting showed an adequate rate of resolution of deep wounds with low morbidity. PMID:25289363

Surgical Management of Recurrent Musculotendinous Hamstring Injury in Professional Athletes

PubMed Central

Sonnery-Cottet, Bertrand; Daggett, Matt; Gardon, Roland; Pupim, Barbara; Clechet, Julien; Thaunat, Mathieu

2015-01-01

Background: Hamstring injury is the most common muscular lesion in athletes. The conservative treatment is well described, and surgical management is often indicated for proximal tendinous avulsions. To our knowledge, no surgical treatment has been proposed for failure of conservative treatment in musculotendinous hamstring lesions. Purpose: To describe the surgical management of proximal and distal hamstring musculotendinous junction lesions in professional athletes after failure of conservative treatment. Study Design: Case series; Level of evidence, 4. Methods: A consecutive series of 10 professional athletes, including 4 soccer players, 4 rugby players, and 2 handball players, underwent surgical intervention between October 2010 and June 2014 for the treatment of recurrent musculotendinous hamstring injuries. All athletes had failed at least 3 months of conservative treatment for a recurrent musculotendinous hamstring injury. Surgical resection of the musculotendinous scar tissue was performed using a longitudinal muscular suture. Lower Extremity Functional Scale (LEFS) and Marx scores were obtained at the 3-month follow-up, and a final phone interview was completed to determine recurrence of hamstring injury and return to previous level of play. Results: The mean age at surgery was 25.2 years (range, 19-35 years). The musculotendinous hamstring lesions involved 8 semitendinosus and 2 biceps femoris, with 6 injuries located proximally and 4 distally. Conservative treatment lasted a mean 5.1 months (range, 3-9 months) after last recurrence, and the patients had an average of 2.7 (range, 2-5) separate incidents of injury recurrence before surgical intervention was decided upon. At the 3-month follow-up, all patients had Marx activity scores of 16 and LEFS scores of 80. All 10 patients returned to the same level of play at a mean 3.4 months (range, 2-5 months). At a mean follow-up of 28.7 months, none of the athletes had suffered a recurrence. No surgical

The prevalence of proximal hamstring pathology on MRI in the asymptomatic population.

PubMed

Thompson, S M; Fung, S; Wood, D G

2017-01-01

Injury to the proximal hamstring complex (PHC) is becoming more frequently diagnosed. Patients attending our tertiary referral centre demonstrated 'pathological changes' in the unaffected normal contralateral PHC on MRI. The prevalence of PHC pathology, however, has not been previously documented in the literature in asymptomatic subjects. It is the hypothesis of this study that the natural history of asymptomatic pathological change on MRI in the PHC is not clear. The aim is to quantify the natural history of PHC degeneration. Two hundred and fifty-three consecutive patients with an asymptomatic PHC were reviewed retrospectively between 2009 and 2010. The PHC was assessed in multiple MRI planes by a specialist musculoskeletal consultant radiologist. Five hundred and six proximal hamstrings complexes were reviewed. Eighty-nine patients (35 %) were radiological normal both sides, median age 51 years (range 13-88). Thirty-four patients (13 %) had unilateral pathology, median age 55 years (range 25-89). Of these, 3 patients (1 %) had presence of a complete tear, median age 81 years (range 72-87). Sixteen patients (7 %) had tendinosis, median age 60 years (range 37-78). Fifteen patients (6 %) had a unilateral partial tear, median age 57 years (range 35-78). One hundred and thirty patients (52 %) had bilateral pathology, median age 65 years (range 25-89). Fifty-three patients (21 %) had the presence of bilateral tendinopathy alone, median age 56 years (range 25-89). Twenty-seven patients (11 %) had a partial tear on one side and tendinosis on the other, median age 68 years (range 38-89). Thirty-nine patients (15 %) had evidence of bilateral partial tears, median age 63 years (range 36-89), with 52 % demonstrating a torn conjoined and semi-membranosus tendon. The remaining 48 % had either an isolated tear of the conjoined or the semi-membranosus (the more commonly injured tendon 74 % of the time). Four patients (2 %) had bilateral complete ruptures

Treatment of proximal hamstring tendinopathy-related sciatic nerve entrapment: presentation of an ultrasound-guided “Intratissue Percutaneous Electrolysis” application

PubMed Central

Mattiussi, Gabriele; Moreno, Carlos

2016-01-01

Summary Background Proximal Hamstring Tendinopathy-related Sciatic Nerve Entrapment (PHTrSNE) is a neuropathy caused by fibrosis interposed between the semimembranosus tendon and the sciatic nerve, at the level of the ischial tuberosity. Methods Ultrasound-guided Intratissue Percutaneous Electrolysis (US-guided EPI) involves galvanic current transfer within the treatment target tissue (fibrosis) via a needle 0.30 to 0.33 mm in diameter. The galvanic current in a saline solution instantly develops the chemical process of electrolysis, which in turn induces electrochemical ablation of fibrosis. In this article, the interventional procedure is presented in detail, and both the strengths and limits of the technique are discussed. Results US-guided EPI eliminates the fibrotic accumulation that causes PHTrSNE, without the semimembranosus tendon or the sciatic nerve being directly involved during the procedure. The technique is however of limited use in cases of compression neuropathy. Conclusion US-guided EPI is a technique that is quick to perform, minimally invasive and does not force the patient to suspend their activities (work or sports) to make the treatment effective. This, coupled to the fact that the technique is generally well-tolerated by patients, supports use of US-guided EPI in the treatment of PHTrSNE. PMID:27900300

Hamstring Muscle Fatigue and Central Motor Output during a Simulated Soccer Match

PubMed Central

Marshall, Paul W. M.; Lovell, Ric; Jeppesen, Gitte K.; Andersen, Kristoffer; Siegler, Jason C.

2014-01-01

Purpose To examine changes in hamstring muscle fatigue and central motor output during a 90-minute simulated soccer match, and the concomitant changes in hamstring maximal torque and rate of torque development. Method Eight amateur male soccer players performed a 90-minute simulated soccer match, with measures performed at the start of and every 15-minutes during each half. Maximal torque (Nm) and rate of torque development (RTD; Nm.s–1) were calculated from maximal isometric knee flexor contractions performed at 10° of flexion. Hamstring peripheral fatigue was assessed from changes in the size and shape of the resting twitch (RT). Hamstring central motor output was quantified from voluntary activation (%) and normalized biceps femoris (BF) and medial hamstrings (MH) electromyographic amplitudes (EMG/M). Results Maximal torque was reduced at 45-minutes by 7.6±9.4% (p<0.05). RTD in time intervals of 0–25, 0–50, and 0–75 ms post-contraction onset were reduced after 15-minutes in the first-half between 29.6 to 46.2% (p<0.05), and were further reduced at the end of the second-half (p<0.05). Maximal EMG/M was reduced for biceps femoris only concomitant to the time-course of reductions in maximal torque (p = 0.007). The rate of EMG rise for BF and MH was reduced in early time periods (0–75 ms) post-contraction onset (p<0.05). No changes were observed for the size and shape of the RT, indicating no hamstring peripheral fatigue. Conclusion Centrally mediated reductions in maximal torque and rate of torque development provide insight into factors that may explain hamstring injury risk during soccer. Of particular interest were early reductions during the first-half of hamstring rate of torque development, and the decline in maximal EMG/M of biceps femoris in the latter stages of the half. These are important findings that may help explain why the hamstrings are particularly vulnerable to strain injury during soccer. PMID:25047547

A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note.

PubMed

Sillanpää, Petri J; Mäenpää, Heikki M; Mattila, Ville M; Visuri, Tuomo; Pihlajamäki, Harri

2009-05-01

Patellar dislocations are associated with injuries to the medial patellofemoral ligament (MPFL). Several techniques for MPFL reconstruction have been recently published with some disadvantages involved, including large skin incisions and donor site morbidity. Arthroscopic stabilizing techniques carry the potential of inadequate restoration of MPFL function. We present a minimally invasive technique for MPFL reconstruction using adductor magnus tendon autograft. This technique is easily performed, safe, and provides a stabilizing effect equal to current MPFL reconstructions. Skin incision of only 3-4 cm is located at the level of the proximal half of the patella. After identifying the distal insertion of the adductor magnus tendon, a tendon harvester is introduced to harvest the medial two-thirds of the tendon, while the distal insertion is left intact. The adductor magnus tendon is cut at 12-14 cm from its distal insertion and transferred into the patellar medial margin. Two suture anchors are inserted through the same incision at the superomedial aspect of the patella in the anatomic MPFL origin. The graft is tightened at 30 degrees knee flexion. Aftercare includes 4 weeks of brace treatment with restricted range of motion.

Hamstrings Stiffness and Landing Biomechanics Linked to Anterior Cruciate Ligament Loading

PubMed Central

Blackburn, J. Troy; Norcross, Marc F.; Cannon, Lindsey N.; Zinder, Steven M.

2013-01-01

Context: Greater hamstrings stiffness is associated with less anterior tibial translation during controlled perturbations. However, it is unclear how hamstrings stiffness influences anterior cruciate ligament (ACL) loading mechanisms during dynamic tasks. Objective: To evaluate the influence of hamstrings stiffness on landing biomechanics related to ACL injury. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: A total of 36 healthy, physically active volunteers (18 men, 18 women; age = 23 ± 3 years, height = 1.8 ± 0.1 m, mass = 73.1 ± 16.6 kg). Intervention(s): Hamstrings stiffness was quantified via the damped oscillatory technique. Three-dimensional lower extremity kinematics and kinetics were captured during a double-legged jump-landing task via a 3-dimensional motion-capture system interfaced with a force plate. Landing biomechanics were compared between groups displaying high and low hamstrings stiffness via independent-samples t tests. Main Outcome Measure(s): Hamstrings stiffness was normalized to body mass (N/m·kg−1). Peak knee-flexion and -valgus angles, vertical and posterior ground reaction forces, anterior tibial shear force, internal knee-extension and -varus moments, and knee-flexion angles at the instants of each peak kinetic variable were identified during the landing task. Forces were normalized to body weight, whereas moments were normalized to the product of weight and height. Results: Internal knee-varus moment was 3.6 times smaller in the high-stiffness group (t22 = 2.221, P = .02). A trend in the data also indicated that peak anterior tibial shear force was 1.1 times smaller in the high-stiffness group (t22 = 1.537, P = .07). The high-stiffness group also demonstrated greater knee flexion at the instants of peak anterior tibial shear force and internal knee-extension and -varus moments (t22 range = 1.729–2.224, P < .05). Conclusions: Greater hamstrings stiffness was associated with landing

Hip and trunk muscles activity during nordic hamstring exercise.

PubMed

Narouei, Shideh; Imai, Atsushi; Akuzawa, Hiroshi; Hasebe, Kiyotaka; Kaneoka, Koji

2018-04-01

The nordic hamstring exercise (NHE) is a dynamic lengthening hamstring exercise that requires trunk and hip muscles activation. Thigh muscles activation, specifically hamstring/quadriceps contractions has been previously examined during NHE. Trunk and hip muscles activity have not been enough studied. The aim of this study was to analyze of hip and trunk muscles activity during NHE. Surface electromyography (EMG) and kinematic data were collected during NHE. Ten healthy men with the age range of 21-36 years performed two sets of two repetitions with downward and upward motions each of NHE. EMG activity of fifteen trunk and hip muscles and knee kinematic data were collected. Muscle activity levels were calculated through repeated measure analysis of variance in downward and upward motions, through Paired t -test between downward and upward motions and gluteus maximus to erector spine activity ratio (Gmax/ES ratio) using Pearson correlation analyses were evaluated. Semitendinosus and biceps femoris muscles activity levels were the greatest in both motions and back extensors and internal oblique muscles activity were greater than other muscles ( P <0.05). The decreased Gmax/ES ratio was significantly related to peak knee extension angle in downward ( r =0.687) and upward motions ( r =0.753) ( P <0.05). These findings indicate the importance of synergistic muscles and trunk muscles coactivation in eccentric and concentric hamstrings contractions. It could be important for early assessment of subjects with hamstring injury risk.

Hip and trunk muscles activity during nordic hamstring exercise

PubMed Central

Narouei, Shideh; Imai, Atsushi; Akuzawa, Hiroshi; Hasebe, Kiyotaka; Kaneoka, Koji

2018-01-01

The nordic hamstring exercise (NHE) is a dynamic lengthening hamstring exercise that requires trunk and hip muscles activation. Thigh muscles activation, specifically hamstring/quadriceps contractions has been previously examined during NHE. Trunk and hip muscles activity have not been enough studied. The aim of this study was to analyze of hip and trunk muscles activity during NHE. Surface electromyography (EMG) and kinematic data were collected during NHE. Ten healthy men with the age range of 21–36 years performed two sets of two repetitions with downward and upward motions each of NHE. EMG activity of fifteen trunk and hip muscles and knee kinematic data were collected. Muscle activity levels were calculated through repeated measure analysis of variance in downward and upward motions, through Paired t-test between downward and upward motions and gluteus maximus to erector spine activity ratio (Gmax/ES ratio) using Pearson correlation analyses were evaluated. Semitendinosus and biceps femoris muscles activity levels were the greatest in both motions and back extensors and internal oblique muscles activity were greater than other muscles (P<0.05). The decreased Gmax/ES ratio was significantly related to peak knee extension angle in downward (r=0.687) and upward motions (r=0.753) (P<0.05). These findings indicate the importance of synergistic muscles and trunk muscles coactivation in eccentric and concentric hamstrings contractions. It could be important for early assessment of subjects with hamstring injury risk. PMID:29740557

A return-to-sport algorithm for acute hamstring injuries.

PubMed

Mendiguchia, Jurdan; Brughelli, Matt

2011-02-01

Acute hamstring injuries are the most prevalent muscle injuries reported in sport. Despite a thorough and concentrated effort to prevent and rehabilitate hamstring injuries, injury occurrence and re-injury rates have not improved over the past 28 years. This failure is most likely due to the following: 1) an over-reliance on treating the symptoms of injury, such as subjective measures of "pain", with drugs and interventions; 2) the risk factors investigated for hamstring injuries have not been related to the actual movements that cause hamstring injuries i.e. not functional; and, 3) a multi-factorial approach to assessment and treatment has not been utilized. The purpose of this clinical commentary is to introduce a model for progression through a return-to-sport rehabilitation following an acute hamstring injury. This model is developed from objective and quantifiable tests (i.e. clinical and functional tests) that are structured into a step-by-step algorithm. In addition, each step in the algorithm includes a treatment protocol. These protocols are meant to help the athlete to improve through each phase safely so that they can achieve the desired goals and progress through the algorithm and back to their chosen sport. We hope that this algorithm can serve as a foundation for future evidence based research and aid in the development of new objective and quantifiable testing methods. Copyright © 2010 Elsevier Ltd. All rights reserved.

Hamstring tightness and Scheuermann's disease a pilot study.

PubMed

Fisk, J W; Baigent, M L

1981-06-01

The lateral radiographs of the dorsal spines of 20 patients presenting with mainly low back pain are studied. These patients had clinically evident loss of flexion in the low dorsal spine and very tight hamstring muscles. 85% of them showed definite evidence of previous Scheuermann's Disease. The possibility that tight hamstrings may be an important factor in the aetiology of this disease is discussed, and a further large scale study is proposed.

Eccentric Exercises Reduce Hamstring Strains in Elite Adult Male Soccer Players: A Critically Appraised Topic.

PubMed

Shadle, Ian B; Cacolice, Paul A

2017-11-01

Clinical Scenario: Hamstring strains are a common sport-related injury, which may limit athletic performance for an extended period of time. These injuries are common in the soccer setting. As such, it is important to determine an appropriate prevention program to minimize the risk of such an injury for these athletes. Eccentric hamstring training may be an effective and practical hamstring strain prevention strategy. What is the effect of eccentric exercises on hamstring strain prevention in adult male soccer players? Summary of Key Findings: Current literature was searched for studies of level 2 evidence or higher that investigated the effect of eccentric exercises in preventing hamstring strains in adult male soccer players. Three articles returned from the literature search met the inclusion criteria. A fourth article looked at differences in strength gains between eccentric and concentric hamstring strengthening exercises, but did not record hamstring strain incidence. A fifth article, a systematic review, met all the criteria except for the correct population. Of the 3 studies, 2 were randomized control trails and 1 was a cohort study. Clinical Bottom Line: There is robust supportive evidence that eccentric hamstring exercises can prevent a hamstring injury to an elite adult male soccer player. Therefore, it is recommended that athletic trainers and other sports medicine providers evaluate current practices relating to reducing hamstring strains and consider implementing eccentric exercise based prevention programs. Strength of Recommendation: All evidence was attained from articles with a level of evidence 2b or higher, based on the Center for Evidence-Based Medicine (CEBM) criteria, stating that eccentric exercises can decrease hamstring strains.

Current Trends in Anterior Cruciate Ligament Reconstruction: A Review

PubMed Central

Vaishya, Raju; Ingole, Sachin; Vijay, Vipul

2015-01-01

Anterior cruciate ligament reconstruction (ACLR) is an accepted and established surgical technique for anterior cruciate ligament (ACL) injuries and is now being practiced across the globe in increasing numbers. Although most patients get good to excellent results in the short-term after ACLR, its consequences in the long-term in prevention or acceleration of knee osteoarthritis (OA) are not yet well-defined. Still, there are many debatable issues related to ACLR, such as the appropriate timing of surgery, graft selection, fixation methods of the graft, operative techniques, rehabilitation after surgery, and healing augmentation techniques. Most surgeons prefer not to wait long after an ACL injury to do an ACLR, as delayed reconstruction is associated with secondary damages to the intra- and periarticular structures of the knee. Autografts are the preferred choice of graft in primary ACLR, and hamstring tendons are the most popular amongst surgeons. Single bundle ACLR is being practiced by the majority, but double bundle ACLR is getting popular due to its theoretical advantage of providing more anatomical reconstruction. A preferred construct is the interference fixation (Bio-screw) at the tibial site and the suspensory method of fixation at the femoral site. In a single bundle hamstring graft, a transportal approach for creating a femoral tunnel has recently become more popular than the trans-tibial technique. Various healing augmentation techniques, including the platelet rich plasma (PRP), have been tried after ACLR, but there is still no conclusive proof of their efficacy. Accelerated rehabilitation is seemingly more accepted immediately after ACLR. PMID:26697280

Strength Measurements in Acute Hamstring Injuries: Intertester Reliability and Prognostic Value of Handheld Dynamometry.

PubMed

Reurink, Gustaaf; Goudswaard, Gert Jan; Moen, Maarten H; Tol, Johannes L; Verhaar, Jan A N; Weir, Adam

2016-08-01

Study Design Cohort study, repeated measures. Background Although hamstring strength measurements are used for assessing prognosis and monitoring recovery after hamstring injury, their actual clinical relevance has not been established. Handheld dynamometry (HHD) is a commonly used method of measuring muscle strength. The reliability of HHD has not been determined in athletes with acute hamstring injuries. Objectives To determine the intertester reliability and the prognostic value of hamstring HHD strength measurement in acute hamstring injuries. Methods We measured knee flexion strength with HHD in 75 athletes at 2 visits, at baseline (within 5 days of hamstring injury) and follow-up (5 to 7 days after the baseline measurement). We assessed isometric hamstring strength in 15° and 90° of knee flexion. Reliability analysis testing was performed by 2 testers independently at the follow-up visit. We recorded the time needed to return to play (RTP) up to 6 months following baseline. Results The intraclass correlation coefficients of the strength measurements in injured hamstrings were between 0.75 and 0.83. There was a statistically significant but weak correlation between the time to RTP and the strength deficit at 15° of knee flexion measured at baseline (Spearman r = 0.25, P = .045) and at the follow-up visit (Spearman r = 0.26, P = .034). Up to 7% of the variance in time to RTP is explained by this strength deficit. None of the other strength variables were significantly correlated with time to RTP. Conclusion Hamstring strength can be reliably measured with HHD in athletes with acute hamstring injuries. The prognostic value of strength measurements is limited, as there is only a weak association between the time to RTP and hamstring strength deficit after acute injury. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther 2016;46(8):689-696. Epub 12 May 2016. doi:10.2519/jospt.2016.6363.

Relationship between interchange usage and risk of hamstring injuries in the Australian Football League.

PubMed

Orchard, John W; Driscoll, Tim; Seward, Hugh; Orchard, Jessica J

2012-05-01

To study risk factors for hamstring injury in the Australian Football League (AFL), in particular the effect of recent changes in match participation (increased use of the interchange bench) on hamstring injury. Analysis of hamstring match injury statistics extracted from an injury database combined with match participation statistics extracted from a player statistics database. 56,320 player matches in the AFL over the period 2003-2010 were analyzed, in which 416 hamstring injuries occurred. In a Generalized Estimating Equation (GEE) analysis accounting for clustering of different teams, significant predictors of hamstring injuries were recent hamstring injury (RR 4.16, 95% CI 3.19-5.43), past history of ACL reconstruction (RR 1.69, 95% CI 1.09-2.60), past history of calf injury (RR 1.58, 95% CI 1.37-1.82), opposition team making 60 or more interchanges during the game (RR 1.38, 95% CI 1.12-1.68) and player having made 7 or more interchanges off the field in the last 3 weeks (protective RR 0.74, 95% CI 0.59-0.93). These findings suggest that regular interchanges protect individual players against hamstring injuries, but increase the risk of hamstring injury for opposition players. These findings can be explained by a model in which both fatigue and average match running speed are risk factors for hamstring injury. A player who returns to the ground after a rest on the interchange bench may himself have some short-term protection against hamstring injury because of the reduced fatigue, but his rested state may contribute to increased average running speed for his direct opponent, increasing the risk of injury for players on the opposition team. Copyright © 2011 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

The effectiveness of whole-body-vibration training in improving hamstring flexibility in physically active adults.

PubMed

Houston, Megan N; Hodson, Victoria E; Adams, Kelda K E; Hoch, Johanna M

2015-02-01

Hamstring tightness is common among physically active individuals. In addition to limiting range of motion and increasing the risk of muscle strain, hamstring tightness contributes to a variety of orthopedic conditions. Therefore, clinicians continue to identify effective methods to increase flexibility. Although hamstring tightness is typically treated with common stretching techniques such as static stretching and proprioceptive neuromuscular facilitation, it has been suggested that whole-body-vibration (WBV) training may improve hamstring flexibility. Can WBV training, used in isolation or in combination with common stretching protocols or exercise, improve hamstring flexibility in physically active young adults? Summary of Key Findings: Of the included studies, 4 demonstrated statistically significant improvements in hamstring flexibility in the intervention group, and 1 study found minor improvements over time in the intervention group after treatment. Clinical Bottom Line: There is moderate evidence to support the use of WBV training to improve hamstring flexibility in physically active young adults. There is grade B evidence that WBV training improves hamstring flexibility in physically active adults. The Centre of Evidence Based Medicine recommends a grade of B for level 2 evidence with consistent findings.

Does a 'tight' hamstring predict low back pain reporting during prolonged standing?

PubMed

Raftry, Sean M; Marshall, Paul W M

2012-06-01

The purpose of this study was to investigate the relationship between hamstring passive stiffness and extensibility in asymptomatic individuals with the reporting of low back pain during 2-h prolonged standing. Twenty healthy participants with no history of low back pain (mean±SD, age 22.6±2.7 years, height 1.74±0.09 m, weight 76.2±14.8 kg). Low back pain (VAS score; mm) was continuously monitored during 2-h prolonged standing. Hamstring extensibility, passive stiffness, and stretch tolerance were measured before and after prolonged standing using an instrumented straight leg raise (iSLR). Ten participants reported a clinically relevant increase (Δ VAS>10mm) in low back pain during prolonged standing. Hamstring extensiblity (leg°(max)), passive stiffness (Nm.°(-1)), and stretch tolerance (VAS; mm) were no different between pain developers and non-pain developers. No changes in hamstring measures were observed following 2-h prolonged standing. No relationship was observed in this study between measures of hamstring extensibility and the reporting of low back pain during prolonged standing. There is no evidence to recommend hamstring extensibility interventions (i.e. passive stretching) as a means of reducing pain reporting in occupations requiring prolonged standing. Copyright © 2012 Elsevier Ltd. All rights reserved.

Biomechanical characterization of double-bundle femoral press-fit fixation techniques.

PubMed

Ettinger, M; Haasper, C; Hankemeier, S; Hurschler, C; Breitmeier, D; Krettek, C; Jagodzinski, M

2011-03-01

Press-fit fixation of patellar tendon bone anterior cruciate ligament autografts is an interesting technique because no hardware is necessary. To date, no biomechanical data exist describing an implant-free double-bundle press-fit procedure. The purpose of this study was to characterize the biomechanical properties of three double-bundle press-fit fixations. In a controlled laboratory study, the patellar-, quadriceps- and hamstring tendons of 10 human cadavers (age: 49.2 ± 18.5 years) were used. An inside out press-fit fixation with a knot in the semitendinosus and gracilis tendons (SG) combined with an additional bone block, with two quadriceps tendon bone block grafts (QU) was compared with press-fit fixation of two bone patellar tendon bone block (PT) grafts in 30 porcine femora. Constructs were cyclically stretched and then loaded until failure. Maximum load to failure, stiffness and elongation during failure testing and cyclical loading were investigated. The maximum load to failure was 703 ± 136 N for SG fixation, 632 ± 130 N for QU and 656 ± 127 N for PT fixation. Stiffness of the constructs averaged 138 ± 26 N/mm for SG, 159 ± 74 N/mm for QU, and 154 ± 50 N/mm for PT fixation. Elongation during initial cyclical loading was 1.2 ± 1.4 mm for SG, 2.0 ± 1.4 mm for QU, and 1.0 ± 0.6 mm for PT (significantly larger for PT and QU between the first 5 cycles compared with cycles 15-20th, P < 0.01). All investigated double-bundle fixation techniques were equal in terms of maximum load to failure, stiffness, and elongation. Unlike with single-bundle press-fit fixation techniques that have been published, no difference was observed between pure tendon combined with an additional bone block and tendon bone grafts. All techniques exhibited larger elongation during initial cyclical loading. All three press-fit fixation techniques that were investigated exhibit comparable biomechanical properties. Preconditioning of the constructs

Acute effects of different dynamic exercises on hamstring strain risk factors.

PubMed

Chen, Che Hsiu; Xin, Ye; Lee, Kuang Wu; Lin, Ming Ju; Lin, Jiu Jenq

2018-01-01

The purpose of the study was to examine the acute effects of different dynamic exercise interventions on hamstring muscle performance. Thirty-six young men with poor hamstring flexibility were randomly assigned to three intervention groups: jogging combined with dynamic open kinetic chain stretching (DS), jogging combined with dynamic closed kinetic chain stretching (lunge with eccentric hamstring windmills, LEC), and jogging only (CON) groups. Hamstring flexibility, muscle stiffness (area under the curve, AUC), joint position sense (JPS), maximal eccentric strength (ECC), and angle of peak torque (APT) were recorded before and immediately after the exercise interventions. The results showed that the hamstring flexibility increased in DS (p < 0.001); muscle stiffness decreased in DS and was lower than jogging (p < 0.001). Moreover, ECC increased in LEC and was higher than jogging and DS (p < 0.001). APT was different among 3 groups (p < 0.001). Decreased accuracy of JPS was found in DS and jogging (p < 0.001). In conclusion, the dynamic closed kinetic chain stretching (LEC) as compared to open kinetic chain stretching (DS) or jogging group, may be an effective technique to enhance muscle performance during the pre-competition warm-up routine.

Acute effects of different dynamic exercises on hamstring strain risk factors

PubMed Central

Xin, Ye; Lee, Kuang Wu; Lin, Ming Ju

2018-01-01

The purpose of the study was to examine the acute effects of different dynamic exercise interventions on hamstring muscle performance. Thirty-six young men with poor hamstring flexibility were randomly assigned to three intervention groups: jogging combined with dynamic open kinetic chain stretching (DS), jogging combined with dynamic closed kinetic chain stretching (lunge with eccentric hamstring windmills, LEC), and jogging only (CON) groups. Hamstring flexibility, muscle stiffness (area under the curve, AUC), joint position sense (JPS), maximal eccentric strength (ECC), and angle of peak torque (APT) were recorded before and immediately after the exercise interventions. The results showed that the hamstring flexibility increased in DS (p < 0.001); muscle stiffness decreased in DS and was lower than jogging (p < 0.001). Moreover, ECC increased in LEC and was higher than jogging and DS (p < 0.001). APT was different among 3 groups (p < 0.001). Decreased accuracy of JPS was found in DS and jogging (p < 0.001). In conclusion, the dynamic closed kinetic chain stretching (LEC) as compared to open kinetic chain stretching (DS) or jogging group, may be an effective technique to enhance muscle performance during the pre-competition warm-up routine. PMID:29390001

Decellularized Tendon Extracellular Matrix—A Valuable Approach for Tendon Reconstruction?

PubMed Central

Schulze-Tanzil, Gundula; Al-Sadi, Onays; Ertel, Wolfgang; Lohan, Anke

2012-01-01

Tendon healing is generally a time-consuming process and often leads to a functionally altered reparative tissue. Using degradable scaffolds for tendon reconstruction still remains a compromise in view of the required high mechanical strength of tendons. Regenerative approaches based on natural decellularized allo- or xenogenic tendon extracellular matrix (ECM) have recently started to attract interest. This ECM combines the advantages of its intrinsic mechanical competence with that of providing tenogenic stimuli for immigrating cells mediated, for example, by the growth factors and other mediators entrapped within the natural ECM. A major restriction for their therapeutic application is the mainly cell-associated immunogenicity of xenogenic or allogenic tissues and, in the case of allogenic tissues, also the risk of disease transmission. A survey of approaches for tendon reconstruction using cell-free tendon ECM is presented here, whereby the problems associated with the decellularization procedures, the success of various recellularization strategies, and the applicable cell types will be thoroughly discussed. Encouraging in vivo results using cell-free ECM, as, for instance, in rabbit models, have already been reported. However, in comparison to native tendon, cells remain mostly inhomogeneously distributed in the reseeded ECM and do not align. Hence, future work should focus on the optimization of tendon ECM decellularization and recolonization strategies to restore tendon functionality. PMID:24710540

Immediate effects of hamstring stretching alone or combined with ischemic compression of the masseter muscle on hamstrings extensibility, active mouth opening and pain in athletes with temporomandibular dysfunction.

PubMed

Espejo-Antúnez, Luis; Castro-Valenzuela, Elisa; Ribeiro, Fernando; Albornoz-Cabello, Manuel; Silva, Anabela; Rodríguez-Mansilla, Juan

2016-07-01

To assess the immediate effects of hamstrings stretching alone or combined with ischemic compression of the masseter muscle on hamstrings extensibility, active mouth opening and pain in athletes with temporomandibular dysfunction and hamstrings shortening. Forty-two participants were randomized to receive the stretching technique (n = 21) or the stretching plus the ischemic compression (n = 21). Outcome measures were: hamstrings extensibility, active mouth opening, pressure pain thresholds and pain intensity. Both interventions improved significantly active mouth opening (group 1: 35.7 ± 6.7 to 39.1 ± 7.6 mm, p < 0.001; group 2: 34.0 ± 6.2 to 37.6 ± 5.6 mm, p < 0.001), active knee extension (group 1: 33.1 ± 8.5 to 40.8 ± 8.2°, p < 0.001; group 2: 28.9 ± 6.5 to 35.5 ± 6.4°, p < 0.001) and pain. No significant differences were found between interventions. Hamstrings stretching induced an acute improvement in hamstrings extensibility, active mouth opening and pain. Moreover, the addition of ischemic compression did not induce further improvements on the assessed parameters. Copyright © 2016. Published by Elsevier Ltd.

Management of acute Achilles tendon rupture with tendon-bundle technique

PubMed Central

Li, Chun-Guang; Li, Bing

2017-01-01

Objective *These authors contributed equally to this work.To explore tendon-bundle technique for treating Achilles tendon rupture with no defects. Methods Patients with full unilateral Achilles tendon rupture with no defects were included. The Achilles tendon medial edge surgical repair approach was used, revealing horsetail-like rupture bundles. Tendon bundles were anatomically realigned and repaired end-to-end using 5-0 sutures. Patients were followed-up for 1 year, and assessed for differences between the repaired versus healthy limb. Results Out of 24 patients (18 male, 6 female; aged 19–56 years) at 1 year following surgery, mean American Orthopaedic Foot and Ankle Society score was 92.4 ± 5.9; mean differences between the surgically repaired versus contralateral side in dorsiflexion and plantarflexion angle were 3.5 ± 2.3° and 5.6 ± 3.2°, respectively; mean difference in calf circumference between the two sides was 0.9 ± 0.5 cm; and mean increase in Achilles tendon width versus the healthy side was 0.8 ± 0.2 cm. By 1 year post-surgery, there were no significant between-side differences in dorsiflexion and plantarflexion angle, or calf circumference. Conclusions Tendon-bundle surgery resulted in good ankle function restoration and low complication rates. Tendon-bundle surgery may reduce blood supply destruction and maximally preserve Achilles tendon length, and may be effective for treating Achilles tendon rupture with no defects. PMID:28222622

[Ultrastructural observation of tendonization of artificial tendon 109HH in rabbit].

PubMed

Liu, L; Cao, Q; Xiao, H

1995-09-01

Ten New Zealand rabbits were divided into 5 groups at random. Calcaneal tendons were cut bilaterally, then atificial tendon 109HH was used to connect the two ends of the cut tendon. Ultrastructural changes of control group and experimental groups at 2, 6, 12, 28 weeks after section were observed. The results showed that fibroblast proliferated and a lot of ribosome and RER appeared in plasm during 2 approximately 6 weeks, indicating artificial tendon caused fibroblast proliferation. During this period, fibroblast over synthesized collagenous protein and the synthesis of collagenous fibers peaked. During 12-28 weeks, the number of fibroblasts and the synthesis of collagenous protein decreased. Finally, fibroblasts became inactive tendon cells. With the formation of new tendons, the artificial tendens were degradated and absorbed, and disappeared after 12 weeks. The new tendon fibers became thicker and had the correct direction through reconstruction. The structure and function of new tendons could be restored to be consistent with normal values.

[Rheumatic tendon pathologies].

PubMed

Thomas, M; Jordan, M

2014-11-01

Rheumatoid arthritis is found in approximately 2 % of the total population in Europe and the peak incidence of the disease is during the fourth and fifth decades of life. In approximately 15 % the first symptoms of the disease occur at the level of the foot and ankle. If the early stage-dependent therapy with pharmaceuticals fails isolated surgery of the tendons (e.g. tenosynovectomy) and reconstructive surgery including the tendons (e.g. tendon transfer and tendon readaptation) are performed to keep the patient mobile. The aim of this article is to give an overview of the most commonly used interventions in the reconstruction of tendons in rheumatism patients and the corresponding indications. The conservative therapy options for rheumatic foot and ankle alterations with a special emphasis on tendon pathologies have a well-established importance and are also presented. A selective literature search was carried out for therapeutic options of rheumatic tendon pathologies. If possible attempts should be made to preserve functional qualities using tenosynovectomy, tendon sutures or tendon transfer operations. If joints are already destroyed or dislocated, tendon operations should be carried out only as combined interventions with arthrodesis, endoprostheses or resection arthroplasty. The time window in which these interventions are possible should not be missed. Orthotic devices, bandages or even orthopedic shoes provide external support and splinting but do not represent a causal therapy.

Prospective multicentre study of the clinical and functional outcomes following quadriceps tendon repair with suture anchors.

PubMed

Mille, F; Adam, A; Aubry, S; Leclerc, G; Ghislandi, X; Sergent, P; Garbuio, P

2016-01-01

Quadriceps tendon avulsions are typically treated by reattaching the tendon through bone tunnels, with or without tendon or hardware augmentation. The operated knee joint can be moved right away; however, tendon grafting or tension banding will be required to protect the repair, and the hardware must be removed later on. The goal of this study was to evaluate the clinical and functional outcomes when suture anchors are used to reattached torn quadriceps tendon, and also to assess tendon healing using MRI. Thirteen consecutive patients with avulsed quadriceps tendons were operated and then followed prospectively. The surgical technique consisted of tendon reattachment using at least three anchors, in addition to intratendinous weaving of the sutures. Weight bearing was allowed while using a splint. Rehabilitation was initiated immediately after surgery according to a set protocol. Eleven patients were followed for a mean of 14.7 months. Two retears occurred in patients who did not wear the splint. Eighty-two per cent of patients were satisfied or very satisfied with the outcome. The mean knee flexion was 124.5°. All patients were able to return to their pre-injury activity levels. The mean time for clinical and functional recovery was 3 months. MRI performed 6 months after the surgical repair revealed good tendon healing. This was the first prospective study performed on quadriceps avulsion patients undergoing suture anchor repair. Prior clinical case reports have shown that this method leads to predictable clinical and functional results. Our results were comparable to those in published cases. The procedure is simpler when only suture anchors are used. Tendon healing was observed on MRI in all cases. This simple, reproducible technique is free of the drawbacks associated with the typical repair augmentation.

Biologics for tendon repair☆

PubMed Central

Docheva, Denitsa; Müller, Sebastian A.; Majewski, Martin; Evans, Christopher H.

2015-01-01

Tendon injuries are common and present a clinical challenge to orthopedic surgery mainly because these injuries often respond poorly to treatment and require prolonged rehabilitation. Therapeutic options used to repair ruptured tendons have consisted of suture, autografts, allografts, and synthetic prostheses. To date, none of these alternatives has provided a successful long-term solution, and often the restored tendons do not recover their complete strength and functionality. Unfortunately, our understanding of tendon biology lags far behind that of other musculoskeletal tissues, thus impeding the development of new treatment options for tendon conditions. Hence, in this review, after introducing the clinical significance of tendon diseases and the present understanding of tendon biology, we describe and critically assess the current strategies for enhancing tendon repair by biological means. These consist mainly of applying growth factors, stem cells, natural biomaterials and genes, alone or in combination, to the site of tendon damage. A deeper understanding of how tendon tissue and cells operate, combined with practical applications of modern molecular and cellular tools could provide the long awaited breakthrough in designing effective tendon-specific therapeutics and overall improvement of tendon disease management. PMID:25446135

Anatomy of the Pudendal Nerve and Other Neural Structures Around the Proximal Hamstring Origin in Males.

PubMed

Cvetanovich, Gregory L; Saltzman, Bryan M; Ukwuani, Gift; Frank, Rachel M; Verma, Nikhil N; Bush-Joseph, Charles A; Nho, Shane J

2018-03-29

To define the anatomy of the pudendal nerve in relationship to the proximal hamstring and other nearby neurological structures during proximal hamstring repair. Six fresh-frozen human cadaveric hemi-pelvises from male patients ages 64.0 ± 4.1 years were dissected in prone position with hips in 10° flexion to identify the relationship of proximal hamstring origin to surrounding neurologic structures including the pudendal nerve, sciatic nerve, and posterior femoral cutaneous nerve. Two independent observers used digital calipers to measure distances. The pudendal nerve emerged at the inferior border of the piriformis muscle 6.3 ± 1.4 cm from the superior aspect of the proximal hamstring origin. It passed the superior border of the sacrotuberous ligament 3.0 ± 0.6 cm from the superior aspect and 3.9 ± 0.7 cm from the medial aspect of the hamstring origin. It crossed the inferior border of the sacrotuberous ligament 3.0 ± 0.4 cm from the superior aspect and 2.7 ± 0.7 cm from the medial aspect of the proximal hamstring origin. The shortest distance from the hamstring origin to the pudendal nerve was 2.6 ± 0.5 cm from the superior aspect and 2.3 ± 0.8 cm from the medial aspect. The shortest distance from the hamstring origin to the pudendal nerve was located deep to the sacrotuberous ligament in all cadavers. The sciatic nerve was an average of 1.1 ± 0.1 cm lateral to the lateral aspect of the proximal hamstring origin. The posterior femoral cutaneous nerve was located between the hamstring origin and the sciatic nerve, 0.7 ± 0.2 cm lateral to the lateral aspect of the proximal hamstring origin. The proximal hamstring origin lies in close proximity to surrounding nerves, including the pudendal, sciatic, and posterior femoral cutaneous nerves. Knowledge that the pudendal nerve lies 2 to 3 cm superior and medial to the proximal hamstring origin may help to prevent iatrogenic damage during surgical dissection and retraction when performing proximal

Effect of Implanting a Soft Tissue Autograft in a Central-Third Patellar Tendon Defect: Biomechanical and Histological Comparisons

PubMed Central

Kinneberg, Kirsten R. C.; Galloway, Marc T.; Butler, David L.; Shearn, Jason T.

2011-01-01

Previous studies by our laboratory have demonstrated that implanting a stiffer tissue engineered construct at surgery is positively correlated with repair tissue stiffness at 12 weeks. The objective of this study was to test this correlation by implanting a construct that matches normal tissue biomechanical properties. To do this, we utilized a soft tissue patellar tendon autograft to repair a central-third patellar tendon defect. Patellar tendon auto-graft repairs were contrasted against an unfilled defect repaired by natural healing (NH). We hypothesized that after 12 weeks, patellar tendon autograft repairs would have biomechanical properties superior to NH. Bilateral defects were established in the central-third patellar tendon of skeletally mature (one year old), female New Zealand White rabbits (n = 10). In one limb, the excised tissue, the patellar tendon autograft, was sutured into the defect site. In the contralateral limb, the defect was left empty (natural healing). After 12 weeks of recovery, the animals were euthanized and their limbs were dedicated to bio-mechanical (n = 7) or histological (n = 3) evaluations. Only stiffness was improved by treatment with patellar tendon autograft relative to natural healing (p = 0.009). Additionally, neither the patellar tendon autograft nor natural healing repairs regenerated a normal zonal insertion site between the tendon and bone. Immunohistochemical staining for collagen type II demonstrated that fibrocartilage-like tissue was regenerated at the tendon-bone interface for both repairs. However, the tissue was disorganized. Insufficient tissue integration at the tendon-to-bone junction led to repair tissue failure at the insertion site during testing. It is important to re-establish the tendon-to-bone insertion site because it provides joint stability and enables force transmission from muscle to tendon and subsequent loading of the tendon. Without loading, tendon mechanical properties

Tibiofemoral Compression Force Differences Using Laxity- and Force-Based Initial Graft Tensioning Techniques in the ACL-Reconstructed Knee

PubMed Central

Fleming, Braden C.; Brady, Mark F.; Bradley, Michael P.; Banerjee, Rahul; Hulstyn, Michael J.; Fadale, Paul D.

2008-01-01

Purpose To document the tibiofemoral (TF) compression forces produced during clinical initial graft tension protocols. Methods An image analysis system was used to track the position of the tibia relative to the femur in 11 cadaver knees. TF compression forces were quantified using thin-film pressure sensors. Prior to performing ACL reconstructions with patellar tendon grafts, measurements of TF compression force were obtained from the ACL-intact knee with knee flexion. ACL reconstructions were then performed using “force-based” and “laxity-based” graft tension approaches. Within each approach, high- and low-tension conditions were compared to the ACL-intact condition over the range of knee flexion angles. Results The TF compression forces for all initial graft tension conditions were significantly greater than that of the normal knee when the knee was in full extension (0°). The TF compression forces when using the laxity-based approach were greater than those produced with the force-based approach. However the laxity-based approach was necessary to restore normal laxity at the time of surgery. Conclusions The initial graft tension conditions produce different TF compressive force profiles at the time of surgery. A compromise must be made between restoring knee laxity or TF compressive forces when reconstructing the ACL with patellar tendon graft. Clinical Relevance The TF compression forces were greater in the ACL-reconstructed knee for all the initial graft tension conditions when compared to the ACL-intact knee, and that clinically relevant initial graft tension conditions produce different TF compressive forces. PMID:18760214

Joint Angular Velocity in Spastic Gait and the Influence of Muscle-Tendon Lengthening*

PubMed Central

GRANATA, KEVIN P.; ABEL, MARK F.; DAMIANO, DIANE L.

2006-01-01

Background Joint angular velocity (the rate of flexion and extension of a joint) is related to the dynamics of muscle activation and force generation during walking. Therefore, the goal of this research was to examine the joint angular velocity in normal and spastic gait and changes resulting from muscle-tendon lengthening (recession and tenotomy) in patients who have spastic cerebral palsy. Methods The gait patterns of forty patients who had been diagnosed with spastic cerebral palsy (mean age, 8.3 years; range, 3.7 to 14.8 years) and of seventy-three age-matched, normally developing subjects were evaluated with three-dimensional motion analysis and electromyography. The patients who had cerebral palsy were evaluated before muscle-tendon lengthening and nine months after treatment. Results The gait patterns of the patients who had cerebral palsy were characterized by increased flexion of the knee in the stance phase, premature plantar flexion of the ankle, and reduced joint angular velocities compared with the patterns of the normally developing subjects. Even though muscle-tendon lengthening altered sagittal joint angles in gait, the joint angular velocities were generally unchanged at the hip and knee. Only the ankle demonstrated modified angular velocities, including reduced dorsiflexion velocity at foot-strike and improved dorsiflexion velocity through midstance, after treatment. Electromyographic changes included reduced amplitude of the gastrocnemius-soleus during the loading phase and decreased knee coactivity (the ratio of quadriceps and hamstring activation) at toe-off. Principal component analyses showed that, compared with joint-angle data, joint angular velocity was better able to discriminate between the gait patterns of the normal and cerebral palsy groups. Conclusions This study showed that muscle-tendon lengthening corrects biomechanical alignment as reflected by changes in sagittal joint angles. However, joint angular velocity and

Achilles tendon: US examination

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fornage, B.D.

Real-time ultrasonography (US) using linear-array probes and a stand-off pad as a ''waterpath'' was performed to evaluate the Achilles tendon in 67 patients (including 24 athletes) believed to have acute or chronic traumatic or inflammatory pathologic conditions. Tendons in 23 patients appeared normal on US scans. The 44 abnormal tendons comprised five complete and four partial ruptures, seven instances of postoperative change, and 28 cases of tendonitis. US depiction of the inner structure of the tendon resulted in the diagnosis of focal abnormalities, including partial ruptures, nodules, and calcifications. Tendonitis was characterized by enlargement and decreased echogenicity of the tendon.more » The normal US appearance of the Achilles tendon is described.« less

Prone Hip Extension Muscle Recruitment is Associated with Hamstring Injury Risk in Amateur Soccer.

PubMed

Schuermans, Joke; Van Tiggelen, Damien; Witvrouw, Erik

2017-09-01

'Core stability' is considered essential in rehabilitation and prevention. Particularly with respect to hamstring injury prevention, assessment and training of lumbo-pelvic control is thought to be key. However, supporting scientific evidence is lacking. To explore the importance of proximal neuromuscular function with regard to hamstring injury susceptibility, this study investigated the association between the Prone Hip Extension (PHE) muscle activation pattern and hamstring injury incidence in amateur soccer players. 60 healthy male soccer players underwent a comprehensive clinical examination, comprising a range of motion assessments and the investigation of the posterior chain muscle activation pattern during PHE. Subsequently, hamstring injury incidence was recorded prospectively throughout a 1.5-season monitoring period. Players who were injured presented a PHE activation pattern that differed significantly from those who did not. Contrary to the controls, hamstring activity onset was significantly delayed (p=0.018), resulting in a shifted activation sequence. Players were 8 times more likely to get injured if the hamstring muscles were activated after the lumbar erector spinae instead of vice versa (p=0.009). Assessment of muscle recruitment during PHE demonstrated to be useful in injury prediction, suggesting that neuromuscular coordination in the posterior chain influences hamstring injury vulnerability. © Georg Thieme Verlag KG Stuttgart · New York.

Changes in Passive Tension of the Hamstring Muscles During a Simulated Soccer Match.

PubMed

Marshall, Paul W; Lovell, Ric; Siegler, Jason C

2016-07-01

Passive muscle tension is increased after damaging eccentric exercise. Hamstring-strain injury is associated with damaging eccentric muscle actions, but no research has examined changes in hamstring passive muscle tension throughout a simulated sport activity. The authors measured hamstring passive tension throughout a 90-min simulated soccer match (SAFT90), including the warm-up period and every 15 min throughout the 90-min simulation. Passive hamstring tension of 15 amateur male soccer players was measured using the instrumented straight-leg-raise test. Absolute torque (Nm) and slope (Nm/°) of the recorded torque-angular position curve were used for data analysis, in addition to total leg range of motion (ROM). Players performed a 15-min prematch warm-up, then performed the SAFT90 including a 15-min halftime rest period. Reductions in passive stiffness of 20-50° of passive hip flexion of 22.1-29.2% (P < .05) were observed after the warm-up period. During the SAFT90, passive tension increased in the latter 20% of the range of motion of 10.1-10.9% (P < .05) concomitant to a 4.5% increase in total hamstring ROM (P = .0009). The findings of this study imply that hamstring passive tension is reduced after an active warm-up that includes dynamic stretching but does not increase in a pattern suggestive of eccentric induced muscle damage during soccer-specific intermittent exercise. Hamstring ROM and passive tension increases are best explained by improved stretch tolerance.

Radioprotection provides functional mechanics but delays healing of irradiated tendon allografts after ACL reconstruction in sheep.

PubMed

Seto, Aaron U; Culp, Brian M; Gatt, Charles J; Dunn, Michael

2013-12-01

Successful protection of tissue properties against ionizing radiation effects could allow its use for terminal sterilization of musculoskeletal allografts. In this study we functionally evaluate Achilles tendon allografts processed with a previously developed radioprotective treatment based on (1-ethyl-3-(3-dimethylaminopropyl)carbodiimide) crosslinking and free radical scavenging using ascorbate and riboflavin, for ovine anterior cruciate ligament reconstruction. Arthroscopic anterior cruciate ligament (ACL) reconstruction was performed using double looped allografts, while comparing radioprotected irradiated and fresh frozen allografts after 12 and 24 weeks post-implantation, and to control irradiated grafts after 12 weeks. Radioprotection was successful at preserving early subfailure mechanical properties comparable to fresh frozen allografts. Twelve week graft stiffness and anterior-tibial (A-T) translation for radioprotected and fresh frozen allografts were comparable at 30 % of native stiffness, and 4.6 and 5 times native A-T translation, respectively. Fresh frozen allograft possessed the greatest 24 week peak load at 840 N and stiffness at 177 N/mm. Histological evidence suggested a delay in tendon to bone healing for radioprotected allografts, which was reflected in mechanical properties. There was no evidence that radioprotective treatment inhibited intra-articular graft healing. This specific radioprotective method cannot be recommended for ACL reconstruction allografts, and data suggest that future efforts to improve allograft sterilization procedures should focus on modifying or eliminating the pre-crosslinking procedure.

A Comparison of the Quasi-static Mechanical and Nonlinear Viscoelastic Properties of the Human Semitendinosus and Gracilis Tendons

PubMed Central

Abramowitch, Steven D.; Zhang, Xiaoyan; Curran, Molly; Kilger, Robert

2010-01-01

Background Over fifty-percent of anterior cruciate ligament reconstructions are performed using semitendinosus and gracilis tendon autografts. Despite their increased use, there remains little quantitative data on their mechanical behavior. Therefore, the objective of this study was to investigate the quasi-static mechanical and nonlinear viscoelastic properties of human semitendinosus and gracilis tendons, as well as the variation of these properties along their length. Methods Specimens were subjected to a series of uniaxial tensile tests: one-hour static stress-relaxation test, 30-cycle cyclic stress-relaxation test and load to failure test. To describe the nonlinear viscoelastic behavior, the quasi-linear viscoelastic theory was utilized to model data from the static stress relaxation experiment. Findings The constants describing the viscoelastic behavior were similar between the proximal and distal halves of the gracilis tendon. The proximal half of the semitendinosus tendon, however, had a greater viscous response than its distal half, which was also significantly higher than the proximal gracilis tendon. In terms of the quasi-static mechanical properties, the properties were similar between the proximal and distal halves of the semitendinosus tendon. However, the distal gracilis tendon showed a significantly higher tangent modulus and ultimate stress compared to its proximal half, which was also significantly higher than the distal semitendinosus tendon. Interpretation The results of this study demonstrate differences between the semitendinosus and gracilis tendons in terms of their quasi-static mechanical and nonlinear viscoelastic properties. These results are important for establishing surgical preconditioning protocols and graft selection. PMID:20092917

Different roles of the medial and lateral hamstrings in unloading the anterior cruciate ligament.

PubMed

Guelich, David R; Xu, Dali; Koh, Jason L; Nuber, Gordon W; Zhang, Li-Qun

2016-01-01

Anterior cruciate ligament injuries are closely associated with excessive loading and motion about the off axes of the knee, i.e. tibial rotation and knee varus/valgus. However, it is not clear about the 3-D mechanical actions of the lateral and medial hamstring muscles and their differences in loading the ACL. The purpose of this study was to investigate the change in anterior cruciate ligament strain induced by loading the lateral and medial hamstrings individually. Seven cadaveric knees were investigated using a custom testing apparatus allowing for six degree-of-freedom tibiofemoral motion induced by individual muscle loading. With major muscles crossing the knee loaded moderately, the medial and lateral hamstrings were loaded independently to 200N along their lines of actions at 0°, 30°, 60° and 90° of knee flexion. The induced strain of the anterior cruciate ligament was measured using a differential variable reluctance transducer. Tibiofemoral kinematics was monitored using a six degrees-of-freedom knee goniometer. Loading the lateral hamstrings induced significantly more anterior cruciate ligament strain reduction (mean 0.764 [SD 0.63] %) than loading the medial hamstrings (mean 0.007 [0.2] %), (P=0.001 and effect size=0.837) across the knee flexion angles. The lateral and medial hamstrings have significantly different effects on anterior cruciate ligament loadings. More effective rehabilitation and training strategies may be developed to strengthen the lateral and medial hamstrings selectively and differentially to reduce anterior cruciate ligament injury and improve post-injury rehabilitation. The lateral and medial hamstrings can potentially be strengthened selectively and differentially as a more focused rehabilitation approach to reduce ACL injury and improve post-injury rehabilitation. Different ACL reconstruction procedures with some of them involving the medial hamstrings can be compared to each other for their effect on ACL loading. Copyright �

Phenytoin accelerates tendon healing in a rat model of Achilles tendon rupture.

PubMed

Hajipour, B; Navali, A M; Mohammad, S Ali; Mousavi, G; Akbari, M Gahvechi; Miyandoab, T Maleki; Roshangar, L; Saleh, B Mohammadi; Kermani, T Asvadi; Laleh, F Moutab; Ghabili, M

2016-01-01

Tendons are vulnerable to various types of acute or chronic injures. Different methods have been investigated to achieve better healing. Phenytoin is a drug which could stimulate fibroblasts to produce collagen. This experimental study was performed to assess the effect of phenytoin on tendon healing in a rat model of tendon rupture. Thirty healthy rats were divided into 3 groups, 1) Sham group; 2) Tendon rupture; 3) Tendon rupture+phenytoin (100 mg/kg intraperitoneally) for 21 days. On 21st day after tendon injury, the rats were anesthetized and tendon tissue was sampled for studying by light and electron microscopy. Qualitative and quantitative microscopic comparisons of the repair tissues of both groups were made on the 21st day. The results obtained from light and electron microscopy studies showed that tendon tissue healing was significantly better in phenytoin group compared to the control group (p < 0.05). Systemic administration of phenytoin may have a positive effect on tendon healing by increasing fibroblast quantity, fibrillar collagen synthesis, vascularity, and suppressing inflammation (Tab. 2, Ref. 25).

Biochemical, histologic, and biomechanical characterization of native and decellularized flexor tendon specimens harvested from the pelvic limbs of orthopedically normal dogs.

PubMed

Balogh, Daniel G; Biskup, Jeffery J; O'Sullivan, M Gerard; Scott, Ruth M; Groschen, Donna; Evans, Richard B; Conzemius, Michael G

2016-04-01

To evaluate the biochemical and biomechanical properties of native and decellularized superficial digital flexor tendons (SDFTs) and deep digital flexor tendons (DDFTs) harvested from the pelvic limbs of orthopedically normal dogs. 22 commercially supplied tendon specimens (10 SDFT and 12 DDFT) harvested from the pelvic limbs of 13 canine cadavers. DNA, glycosaminoglycan, collagen, and protein content were measured to biochemically compare native and decellularized SDFT and DDFT specimens. Mechanical testing was performed on 4 groups consisting of native tendons (5 SDFTs and 6 DDFTs) and decellularized tendons (5 SDFTs and 6 DDFTs). All tendons were preconditioned, and tension was applied to failure at 0.5 mm/s. Failure mode was video recorded for each tendon. Load-deformation and stress-strain curves were generated; calculations were performed to determine the Young modulus and stiffness. Biochemical and biomechanical data were statistically compared by use of the Wilcoxon rank sum test. Decellularized SDFT and DDFT specimens had significantly less DNA content than did native tendons. No significant differences were identified between native and decellularized specimens with respect to glycosaminoglycan, collagen, or protein content. Biomechanical comparison yielded no significant intra- or intergroup differences. All DDFT constructs failed at the tendon-clamp interface, whereas nearly half (4/10) of the SDFT constructs failed at midsubstance. Decellularized commercial canine SDFT and DDFT specimens had similar biomechanical properties, compared with each other and with native tendons. The decellularization process significantly decreased DNA content while minimizing loss of extracellular matrix components. Decellularized canine flexor tendons may provide suitable, biocompatible graft scaffolds for bioengineering applications such as tendon or ligament repair.

Effects of an Elastic Hamstring Assistance Device During Downhill Running

PubMed Central

Aldret, Randy L; Trahan, Brittany A; Davis, Greggory; Campbell, Brian; Bellar, David M

2017-01-01

Abstract The purpose of this study was to determine the appropriateness of using an elastic hamstring assistance device to reduce perceived levels of soreness, increase isometric strength, increase passive range of motion, and decrease biomarkers of muscle damage after eccentric exercise, specifically, downhill running This study was conducted in a university exercise physiology laboratory placing sixteen apparently healthy males (X = 21.6 ± 2.5 years) into two groups using a pre-test/post-test design. Pre-intervention measures taken included participants’ body height, body mass, body fat, capillary blood samples, VO2max, isometric hamstring strength at 45 and 90 degrees of flexion and passive hamstring range of motion. Post-intervention measures included blood biomarkers, passive range of motion, the perceived level of soreness and isometric strength. An analysis of normality of data was initially conducted followed by multivariate analysis of variance (MANOVA) of hamstring strength at 45 and 90 degrees of flexion, blood myoglobin and passive range of motion of the hamstrings. Statistically significant changes were noted in subject-perceived muscle soreness and isometric strength at 90 degrees at the 24-hour post-exercise trial measure between the two groups. Results would suggest the findings could be explained by the decrease in muscle soreness from utilizing the device during the exercise trial. Further research should be conducted to address sample size issues and to determine if the results are comparable on different surfaces. PMID:28713460

Influence of Passive Stiffness of Hamstrings on Postural Stability

PubMed Central

Kuszewski, Michał; Gnat, Rafał; Sobota, Grzegorz; Myśliwiec, Andrzej

2015-01-01

The aim of the study was to explore whether passive stiffness of the hamstrings influences the strategy of maintaining postural stability. A sample of 50 subjects was selected; the final analyses were based on data of 41 individuals (33 men, 8 women) aged 21 to 29 (mean = 23.3, SD = 1.1) years. A quasi- experimental ex post facto design with repeated measures was used. Categories of independent variables were obtained directly prior to the measurement of the dependent variables. In stage one of the study, passive knee extension was measured in the supine position to assess hamstring stiffness. In stage two, the magnitude of postural sway in antero-posterior direction was measured, while varying the body position on a stabilometric platform, both with and without visual control. The margin of safety was used as a measure of postural control. The magnitude of the margin of safety increased significantly between the open-eye and closed-eye trials. However, although we registered a visible tendency for a larger increase of the margin of safety associated with lower levels of passive hamstrings stiffness, no significant differences were found. Therefore, this study demonstrated that hamstring stiffness did not influence the strategy used to maintain postural stability. PMID:25964809

Influence of passive stiffness of hamstrings on postural stability.

PubMed

Kuszewski, Michał; Gnat, Rafał; Sobota, Grzegorz; Myśliwiec, Andrzej

2015-03-29

The aim of the study was to explore whether passive stiffness of the hamstrings influences the strategy of maintaining postural stability. A sample of 50 subjects was selected; the final analyses were based on data of 41 individuals (33 men, 8 women) aged 21 to 29 (mean = 23.3, SD = 1.1) years. A quasi- experimental ex post facto design with repeated measures was used. Categories of independent variables were obtained directly prior to the measurement of the dependent variables. In stage one of the study, passive knee extension was measured in the supine position to assess hamstring stiffness. In stage two, the magnitude of postural sway in antero-posterior direction was measured, while varying the body position on a stabilometric platform, both with and without visual control. The margin of safety was used as a measure of postural control. The magnitude of the margin of safety increased significantly between the open-eye and closed-eye trials. However, although we registered a visible tendency for a larger increase of the margin of safety associated with lower levels of passive hamstrings stiffness, no significant differences were found. Therefore, this study demonstrated that hamstring stiffness did not influence the strategy used to maintain postural stability.

Preventive Effects of Eccentric Training on Acute Hamstring Muscle Injury in Professional Baseball

PubMed Central

Seagrave, Richard A.; Perez, Luis; McQueeney, Sean; Toby, E. Bruce; Key, Vincent; Nelson, Joshua D.

2014-01-01

Background: Hamstring injuries are the second most common injury causing missed days in professional baseball field players. Recent studies have shown the preventive benefit of eccentric conditioning on the hamstring muscle group in injury prevention. Specifically, Nordic-type exercises have been shown to decrease the incidence of acute hamstring injuries in professional athletes. Purpose: This was a prospective study performed in coordination with a single Major League Baseball (MLB) organization (major and minor league teams) that targeted the effects of Nordic exercises on the incidence of acute hamstring injuries in the professional-level baseball player. Study Design: Prospective cohort study; Level of evidence, 2. Methods: The daily workouts of 283 professional baseball players throughout all levels of a single MLB organization were prospectively recorded. The intervention group participated in the Nordic exercise program and was compared with a randomly selected control group of professional athletes within the organization not participating in the exercise program. The incidence of hamstring injuries in both groups was compared, and the total number of days missed due to injury was compared with the 2 previous seasons. Results: There were 10 hamstring injuries that occurred during the 2012 season among the 283 professional athletes that required removal from play. There were no injuries that occurred in the intervention group (n = 65, 0.00%; P = .0381). The number needed to treat (NNT) to prevent 1 hamstring injury was 11.3. The average repetitions per week of the injured group were assessed at multiple time points (2, 4, 6, and total weeks) prior to injury. There were significantly fewer repetitions per week performed in the injured group at all time points compared with overall average repetitions per week in the noninjured group (P = .0459, .0127, .0164, and .0299, respectively). After beginning the Nordic exercise program, there were 136 total days

Impact of the Nordic hamstring and hip extension exercises on hamstring architecture and morphology: implications for injury prevention.

PubMed

Bourne, Matthew N; Duhig, Steven J; Timmins, Ryan G; Williams, Morgan D; Opar, David A; Al Najjar, Aiman; Kerr, Graham K; Shield, Anthony J

2017-03-01

The architectural and morphological adaptations of the hamstrings in response to training with different exercises have not been explored. To evaluate changes in biceps femoris long head (BF LH ) fascicle length and hamstring muscle size following 10-weeks of Nordic hamstring exercise (NHE) or hip extension (HE) training. 30 recreationally active male athletes (age, 22.0±3.6 years; height, 180.4±7 cm; weight, 80.8±11.1 kg) were allocated to 1 of 3 groups: (1) HE training (n=10), NHE training (n=10), or no training (control, CON) (n=10). BF LH fascicle length was assessed before, during (Week 5) and after the intervention with a two-dimensional ultrasound. Hamstring muscle size was determined before and after training via MRI. Compared with baseline , BF LH fascicles were lengthened in the NHE and HE groups at mid-training (d=1.12-1.39, p<0.001) and post-training (d=1.77-2.17, p<0.001) and these changes did not differ significantly between exercises (d=0.49-0.80, p=0.279-0.976). BF LH volume increased more for the HE than the NHE (d=1.03, p=0.037) and CON (d=2.24, p<0.001) groups. Compared with the CON group, both exercises induced significant increases in semitendinosus volume (d=2.16-2.50, ≤0.002) and these increases were not significantly different (d=0.69, p=0.239). NHE and HE training both stimulate significant increases in BF LH fascicle length; however, HE training may be more effective for promoting hypertrophy in the BF LH . Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Contractile function and motor unit firing rates of the human hamstrings.

PubMed

Kirk, Eric A; Rice, Charles L

2017-01-01

Neuromuscular properties of the lower limb in health, aging, and disease are well described for major lower limb muscles comprising the quadriceps, triceps surae, and dorsiflexors, with the notable exception of the posterior thigh (hamstrings). The purpose of this study was to further characterize major muscles of the lower limb by comprehensively exploring contractile properties in relation to spinal motor neuron output expressed as motor unit firing rates (MUFRs) in the hamstrings of 11 (26.5 ± 3.8) young men. Maximal isometric voluntary contraction (MVC), voluntary activation, stimulated contractile properties including a force-frequency relationship, and MUFRs from submaximal to maximal voluntary contractile intensities were assessed in the hamstrings. Strength and MUFRs were assessed at two presumably different muscle lengths by varying the knee joint angles (90° and 160°). Knee flexion MVCs were 60-70% greater in the extended position (160°). The frequency required to elicit 50% of maximum tetanic torque was 16-17 Hz. Mean MUFRs at 25-50% MVC were 9-31% less in the biceps femoris compared with the semimembranosus-semitendinosus group. Knee joint angle (muscle length) influenced MUFRs such that mean MUFRs were greater in the shortened (90°) position at 50% and 100% MVC. Compared with previous reports, mean maximal MUFRs in the hamstrings are greater than those in the quadriceps and triceps surae and somewhat less than those in the tibialis anterior. Mean maximal MUFRs in the hamstrings are influenced by changes in knee joint angle, with lower firing rates in the biceps femoris compared with the semimembranosus-semitendinosus muscle group. We studied motor unit firing rates (MUFRs) at various voluntary contraction intensities in the hamstrings, one of the only major lower limb muscles to have MUFRs affected by muscle length changes. Within the hamstrings muscle-specific differences have greater impact on MUFRs than length changes, with the biceps femoris

Hamstring and Quadriceps Isokinetic Strength Deficits Are Weak Risk Factors for Hamstring Strain Injuries: A 4-Year Cohort Study.

PubMed

van Dyk, Nicol; Bahr, Roald; Whiteley, Rodney; Tol, Johannes L; Kumar, Bhavesh D; Hamilton, Bruce; Farooq, Abdulaziz; Witvrouw, Erik

2016-07-01

A hamstring strain injury (HSI) has become the most common noncontact injury in soccer. Isokinetic muscle strength deficits are considered a risk factor for HSIs. However, underpowered studies with small sample sizes unable to determine small associations have led to inconclusive results regarding the role of isokinetic strength and strength testing in HSIs. To examine whether differences in isokinetic strength measures of knee flexion and extension represent risk factors for hamstring injuries in a large cohort of professional soccer players in an adequately powered study design. Cohort study; Level of evidence, 2. A total of 614 professional soccer players from 14 teams underwent isokinetic strength testing during preseason screening. Testing consisted of concentric knee flexion and extension at 60 deg/s and 300 deg/s and eccentric knee extension at 60 deg/s. A clustered multiple logistic regression analysis was used to identify variables associated with the risk of HSIs. Receiver operating characteristic (ROC) curves were calculated to determine sensitivity and specificity. Of the 614 players, 190 suffered an HSI during the 4 seasons. Quadriceps concentric strength at 60 deg/s (odds ratio [OR], 1.41; 95% CI, 1.03-1.92; P = .03) and hamstring eccentric strength at 60 deg/s (OR, 1.37; 95% CI, 1.01-1.85; P = .04) adjusted for bodyweight were independently associated with the risk of injuries. The absolute differences between the injured and uninjured players were 6.9 N·m and 9.1 N·m, with small effect sizes (d < 0.2). The ROC analyses showed an area under the curve of 0.54 and 0.56 for quadriceps concentric strength and hamstring eccentric strength, respectively, indicating a failed combined sensitivity and specificity of the 2 strength variables identified in the logistic regression models. This study identified small absolute strength differences and a wide overlap of the absolute strength measurements at the group level. The small associations between lower

Deviating running kinematics and hamstring injury susceptibility in male soccer players: Cause or consequence?

PubMed

Schuermans, Joke; Van Tiggelen, Damien; Palmans, Tanneke; Danneels, Lieven; Witvrouw, Erik

2017-09-01

Although the vast majority of hamstring injuries in male soccer are sustained during high speed running, the association between sprinting kinematics and hamstring injury vulnerability has never been investigated prospectively in a cohort at risk. This study aimed to objectify the importance of lower limb and trunk kinematics during full sprint in hamstring injury susceptibility. Cohort study; level of evidence, 2. At the end of the 2013 soccer season, three-dimensional kinematic data of the lower limb and trunk were collected during sprinting in a cohort consisting of 30 soccer players with a recent history of hamstring injury and 30 matched controls. Subsequently, a 1.5 season follow up was conducted for (re)injury registry. Ultimately, joint and segment motion patterns were submitted to retro- and prospective statistical curve analyses for injury risk prediction. Statistical analysis revealed that index injury occurrence was associated with higher levels of anterior pelvic tilting and thoracic side bending throughout the airborne (swing) phases of sprinting, whereas no kinematic differences during running were found when comparing players with a recent hamstring injury history with their matched controls. Deficient core stability, enabling excessive pelvis and trunk motion during swing, probably increases the primary injury risk. Although sprinting encompasses a relative risk of hamstring muscle failure in every athlete, running coordination demonstrated to be essential in hamstring injury prevention. Copyright © 2017 Elsevier B.V. All rights reserved.

Incidence of Second Anterior Cruciate Ligament Tears and Identification of Associated Risk Factors From 2001 to 2010 Using a Geographic Database

PubMed Central

Schilaty, Nathan D.; Nagelli, Christopher; Bates, Nathaniel A.; Sanders, Thomas L.; Krych, Aaron J.; Stuart, Michael J.; Hewett, Timothy E.

2017-01-01

Background: The reported rate of second anterior cruciate ligament (ACL) injuries (20%-30%), including graft failure and contralateral ACL tears, after ACL reconstruction (ACLR) or nonoperative therapy indicates that multiple factors may predispose patients to subsequent ACL injuries. Purpose: To determine the incidence of second ACL injuries in a population-based cohort over a 10-year observation period (2001-2010) and to identify factors that contribute to the risk of second injuries. Study Design: Descriptive epidemiological study. Methods: International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACLR were utilized to search the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 2001 and 2010. The complete medical records for all cases were reviewed to confirm diagnosis and treatment details. A total of 914 unique patients with 1019 acute, isolated ACL tears were identified. These patients were stratified by primary and secondary tears, sex, age, activity level, side of injury, sex × side of injury, and graft type of reconstruction. Results: Second ACL tears were recorded in 141 (13.8%) of the 914 patients diagnosed with an ACL tear in Olmsted County, Minnesota, USA, from 2001 to 2010; 50.4% of these occurred in the contralateral knee. A noncontact mechanism was responsible for 76.4% of all ACL injuries. A second ACL injury was influenced by factors of sex × age group, treatment type × age group, and treatment type × activity level. Nonparametric analysis of graft disruption × graft type demonstrated that a higher prevalence of second ACL tears occurred with allografts compared with hamstring autografts (P = .0054) and patellar tendon autografts (P = .0001). Conclusion: The incidence of second ACL tears in this population-based cohort was 13.8%, and half occurred to the ACL of the contralateral knee. Statistically, second ACL injuries

Gluteus medius activation during running is a risk factor for season hamstring injuries in elite footballers.

PubMed

Franettovich Smith, Melinda M; Bonacci, Jason; Mendis, M Dilani; Christie, Craig; Rotstein, Andrew; Hides, Julie A

2017-02-01

To investigate if size and activation of the gluteal muscles is a risk factor for hamstring injuries in elite AFL players. Prospective cohort study. Twenty-six elite male footballers from a professional Australian Football League (AFL) club participated in the study. At the beginning of the season bilateral gluteus medius (GMED) and gluteus maximus (GMAX) muscle volume was measured from magnetic resonance images and electromyographic recordings of the same muscles were obtained during running. History of hamstring injury in the pre-season and incidence of hamstring injury during the season were determined from club medical data. Nine players (35%) incurred a hamstring injury during the season. History of hamstring injury was comparable between those players who incurred a season hamstring injury (2/9 players; 22%) and those who did not (3/17 players; 18%). Higher GMED muscle activity during running was a risk factor for hamstring injury (p=0.03, effect sizes 1.1-1.5). There were no statistically significant differences observed for GMED volume, GMAX volume and GMAX activation (P>0.05). This study identified higher activation of the GMED muscle during running in players who sustained a season hamstring injury. Whilst further research is required to understand the mechanism of altered muscle control, the results of this study contribute to the developing body of evidence that the lumbo-pelvic muscles may be important to consider in hamstring injury prevention and management. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Double-bundle ACL reconstruction can improve rotational stability.

PubMed

Yagi, Masayoshi; Kuroda, Ryosuke; Nagamune, Kouki; Yoshiya, Shinichi; Kurosaka, Masahiro

2007-01-01

Double-bundle anterior cruciate ligament (ACL) reconstruction reproduces anteromedial and posterolateral bundles, and thus has theoretical advantages over conventional single-bundle reconstruction in controlling rotational torque in vitro. However, its superiority in clinical practice has not been proven. We analyzed rotational stability with three reconstruction techniques in 60 consecutive patients who were randomly divided into three groups (double-bundle, anteromedial single-bundle, posterolateral single-bundle). In the reconstructive procedure, the hamstring tendon was harvested and used as a free tendon graft. Followup examinations were performed 1 year after surgery. Anteroposterior laxity of the knee was examined with a KT-1000 arthrometer, whereas rotatory instability, as elicited by the pivot shift test, was assessed using a new measurement system incorporating three-dimensional electromagnetic sensors. Routine clinical evaluations, including KT examination, demonstrated no differences among the three groups. However, using the new measurement system, patients with double-bundle ACL reconstruction showed better pivot shift control of complex instability than patients with anteromedial and posterolateral single-bundle reconstruction.

Fos Promotes Early Stage Teno-Lineage Differentiation of Tendon Stem/Progenitor Cells in Tendon.

PubMed

Chen, Jialin; Zhang, Erchen; Zhang, Wei; Liu, Zeyu; Lu, Ping; Zhu, Ting; Yin, Zi; Backman, Ludvig J; Liu, Huanhuan; Chen, Xiao; Ouyang, Hongwei

2017-11-01

Stem cells have been widely used in tendon tissue engineering. The lack of refined and controlled differentiation strategy hampers the tendon repair and regeneration. This study aimed to find new effective differentiation factors for stepwise tenogenic differentiation. By microarray screening, the transcript factor Fos was found to be expressed in significantly higher amounts in postnatal Achilles tendon tissue derived from 1 day as compared with 7-days-old rats. It was further confirmed that expression of Fos decreased with time in postnatal rat Achilles tendon, which was accompanied with the decreased expression of multiply tendon markers. The expression of Fos also declined during regular in vitro cell culture, which corresponded to the loss of tendon phenotype. In a cell-sheet and a three-dimensional cell culture model, the expression of Fos was upregulated as compared with in regular cell culture, together with the recovery of tendon phenotype. In addition, significant higher expression of tendon markers was found in Fos-overexpressed tendon stem/progenitor cells (TSPCs), and Fos knock-down gave opposite results. In situ rat tendon repair experiments found more normal tendon-like tissue formed and higher tendon markers expression at 4 weeks postimplantation of Fos-overexpressed TSPCs derived nonscaffold engineering tendon (cell-sheet), as compared with the control group. This study identifies Fos as a new marker and functional driver in the early stage teno-lineage differentiation of tendon, which paves the way for effective stepwise tendon differentiation and future tendon regeneration. Stem Cells Translational Medicine 2017;6:2009-2019. © 2017 The Authors Stem Cells Translational Medicine published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.

The effects of 4 weeks stretching training to the point of pain on flexibility and muscle tendon unit properties.

PubMed

Muanjai, Pornpimol; Jones, David A; Mickevicius, Mantas; Satkunskiene, Danguole; Snieckus, Audrius; Rutkauskaite, Renata; Mickeviciene, Dalia; Kamandulis, Sigitas

2017-08-01

The purpose of this study was to compare the benefits and possible problems of 4 weeks stretching when taken to the point of pain (POP) and to the point of discomfort (POD). Twenty-six physically active women (20 ± 1.1 years) took part in group-based stretching classes of the hamstring muscles, 4 times per week for 4 weeks, one group one stretching to POD, the other to POP. Passive stiffness, joint range of motion (ROM), maximal isometric torque and concentric knee flexion torque, were measured before training and 2 days after the last training session. Hip flexion ROM increased by 14.1° (10.1°-18.1°) and 19.8° (15.1°-24.5°) and sit-and-reach by 7.6 (5.2-10.0) cm and 7.5 (5.0-10.0) cm for POD and POP, respectively (Mean and 95% CI; p < 0.001 within group; NS between groups), with no evidence of damage in either group. Despite the large increases in flexibility there were no changes in either compliance or viscoelastic properties of the muscle tendon unit (MTU). Hamstrings stretching to POP increased flexibility and had no detrimental effects on muscle function but the benefits were no better than when stretching to POD so there is no justification for recommending painful stretching. The improvements in flexibility over 4 weeks of stretching training appear to be largely due to changes in the perception of pain rather than physical properties of the MTU although less flexible individuals benefited more from the training and increased hamstring muscle length.

Tendon-Holding Capacities of Two Newly Designed Implants for Tendon Repair: An Experimental Study on the Flexor Digitorum Profundus Tendon of Sheep

PubMed Central

Ağır, İsmail; Aytekin, Mahmut Nedim; Başçı, Onur; Çaypınar, Barış; Erol, Bülent

2014-01-01

Background: Two main factors determine the strength of tendon repair; the tensile strength of material and the gripping capacity of a suture configuration. Different repair techniques and suture materials were developed to increase the strength of repairs but none of techniques and suture materials seem to provide enough tensile strength with safety margins for early active mobilization. In order to overcome this problem tendon suturing implants are being developed. We designed two different suturing implants. The aim of this study was to measure tendon-holding capacities of these implants biomechanically and to compare them with frequently used suture techniques Materials and Methods: In this study we used 64 sheep flexor digitorum profundus tendons. Four study groups were formed and each group had 16 tendons. We applied model 1 and model 2 implant to the first 2 groups and Bunnell and locking-loop techniques to the 3rd and 4th groups respectively by using 5 Ticron sutures. Results: In 13 tendons in group 1 and 15 tendons in group 2 and in all tendons in group 3 and 4, implants and sutures pulled out of the tendon in longitudinal axis at the point of maximum load. The mean tensile strengths were the largest in group 1 and smallest in group 3. Conclusion: In conclusion, the new stainless steel tendon suturing implants applied from outside the tendons using steel wires enable a biomechanically stronger repair with less tendon trauma when compared to previously developed tendon repair implants and the traditional suturing techniques. PMID:25067965

Motor imagery during action observation increases eccentric hamstring force: an acute non-physical intervention.

PubMed

Scott, Matthew; Taylor, Stephen; Chesterton, Paul; Vogt, Stefan; Eaves, Daniel Lloyd

2018-06-01

Rehabilitation professionals typically use motor imagery (MI) or action observation (AO) to increase physical strength for injury prevention and recovery. Here we compared hamstring force gains for MI during AO (AO + MI) against two pure MI training groups. Over a 3-week intervention physically fit adults imagined Nordic hamstring exercises in both legs and synchronized this with a demonstration of the same action (AO + MI), or they purely imagined this action (pure MI), or imagined upper-limb actions (pure MI-control). Eccentric hamstring strength gains were assessed using ANOVAs, and magnitude-based inference (MBI) analyses determined the likelihood of clinical/practical benefits for the interventions. Hamstring strength only increased significantly following AO + MI training. This effect was lateralized to the right leg, potentially reflecting a left-hemispheric dominance in motor simulation. MBIs: The right leg within-group treatment effect size for AO + MI was moderate and likely beneficial (d = 0.36), and only small and possibly beneficial for pure MI (0.23). Relative to pure MI-control, effects were possibly beneficial and moderate for AO + MI (0.72), although small for pure MI (0.39). Since hamstring strength predicts injury prevalence, our findings point to the advantage of combined AO + MI interventions, over and above pure MI, for injury prevention and rehabilitation. Implications for rehabilitation While hamstring strains are the most common injury across the many sports involving sprinting and jumping, Nordic hamstring exercises are among the most effective methods for building eccentric hamstring strength, for injury prevention and rehabilitation. In the acute injury phase it is crucial not to overload damaged soft tissues, and so non-physical rehabilitation techniques are well suited to this phase. Rehabilitation professionals typically use either motor imagery or action observation techniques to safely improve physical

Four Weeks of Nordic Hamstring Exercise Reduce Muscle Injury Risk Factors in Young Adults.

PubMed

Ribeiro-Alvares, João Breno; Marques, Vanessa B; Vaz, Marco A; Baroni, Bruno M

2018-05-01

Ribeiro-Alvares, JB, Marques, VB, Vaz, MA, and Baroni, BM. Four weeks of Nordic hamstring exercise reduce muscle injury risk factors in young adults. J Strength Cond Res 32(5): 1254-1262, 2018-The Nordic hamstring exercise (NHE) is a field-based exercise designed for knee-flexor eccentric strengthening, aimed at prevention of muscle strains. However, possible effects of NHE programs on other hamstring injury risk factors remain unclear. The purpose of this study was to investigate the effects of a NHE training program on multiple hamstring injury risk factors. Twenty physically active young adults were allocated into 2 equal-sized groups: control group (CG) and training group (TG). The TG was engaged in a 4-week NHE program, twice a week, 3 sets of 6-10 repetitions; while CG received no exercise intervention. The knee flexor and extensor strength were assessed through isokinetic dynamometry, the biceps femoris long head muscle architecture through ultrasound images, and the hamstring flexibility through sit-and-reach test. The results showed that CG subjects had no significant change in any outcome. TG presented higher percent changes than CG for hamstring isometric peak torque (9%; effect size [ES] = 0.27), eccentric peak torque (13%; ES = 0.60), eccentric work (18%; ES = 0.86), and functional hamstring-to-quadriceps torque ratio (13%; ES = 0.80). The NHE program led also to increased fascicle length (22%; ES = 2.77) and reduced pennation angle (-17%; ES = 1.27) in biceps femoris long head of the TG, without significant changes on muscle thickness. In conclusion, a short-term NHE training program (4 weeks; 8 training sessions) counteracts multiple hamstring injury risk factors in physically active young adults.

[Clinical application of peroneal muscles tendon transposition in repair of Achilles tendon rupture].

PubMed

Jin, Rihao; Jin, Yu; Fang, Xiulin

2006-07-01

To discuss applied anatomy, biomechanics and surgical procedures of long peroneal muscles tendon transposition in repair of occlusive achilles tendon rupture. The blood supply and the morphology of long peroneal muscles tendon were observed in the lower extremity of 50 sides adult specimens and the mechanical tests which stretch load on the tendon were carried out. The methods were designed on the basis of the anatomical characteristics and morphology. Ten patients suffering occlusive Achilles tendon rupture were treated by using long peroneal muscles tendon transposition from March 2001 to July 2004. Among 10 patients, there were 7 males and 3 females, aging 32 to 54 years including 6 cases of jump injury, 2 cases of bruise, 1 case of step vacancy and 1 case of spontaneity injury. The interval between injury and surgery was 6 hours to 7 days in 7 fresh rupture and 21 days to 3 months in 3 old rupture. All cases belonged to occlusive Achilles tendon rupture (8 cases of complete rupture and 2 cases of incomplete rupture). The origin of long peroneal muscles was proximal tibia and fibular head, the end of them was base of first metatarsal bones and medial cuboid. The length of tendon was 13.5 +/- 2.5 cm. The width of origin tendon was 0.9 +/- 0.2 cm and the thickness was 0.3 +/- 0.1 cm; the width on apex of lateral malleolus was 0.7 +/- 0.1 cm and the thickness was 0.4 +/- 0.1 cm, the width on head of cuboid was 0.7 +/- 0.1 cm and the thickness was 0.3 +/- 0.1 cm. The long peroneal muscles tendon had abundant blood supply. The results of mechanical test showed that the biggest load was 2,292.4 +/- 617.3 N on tendon calcaneus, 1,020.4 +/- 175.4 N on long peroneal muscles tendon, 752.0 +/- 165.4 N on peroneus brevis tendon and 938.2 +/- 216.7 N on tibialis posterior tendon. Ten cases of occlusive Achilles tendon rupture achieved healing by first intention and were followed up 18-24 months. No Achilles tendon re-rupture, necrosis of skin or other complications occurred

Influence of Anterior Cruciate Ligament Tear on Thigh Muscle Strength and Hamstring-to-Quadriceps Ratio: A Meta-Analysis.

PubMed

Kim, Hyun-Jung; Lee, Jin-Hyuck; Ahn, Sung-Eun; Park, Min-Ji; Lee, Dae-Hee

2016-01-01

Theoretical compensation after anterior cruciate ligament (ACL) tear could cause quadriceps weakness and hamstring activation, preventing anterior tibial subluxation and affecting the expected hamstring-to-quadriceps ratio. Although quadriceps weakness often occurs after ACL tears, it remains unclear whether hamstring strength and hamstring-to-quadriceps ratio increase in ACL deficient knees. This meta-analysis compared the isokinetic muscle strength of quadriceps and hamstring muscles, and the hamstring-to-quadriceps ratio, of the injured and injured limbs of patients with ACL tears. This meta-analysis included all studies comparing isokinetic thigh muscle strengths and hamstring-to-quadriceps ratio in the injured and uninjured legs of patients with ACL tear, without or before surgery. Thirteen studies were included in the meta-analysis. Quadriceps and hamstring strengths were 22.3 N∙m (95% CI: 15.2 to 29.3 N∙m; P<0.001) and 7.4 N∙m (95% CI: 4.3 to 10.5 N∙m; P<0.001) lower, respectively, on the injured than on the uninjured side. The mean hamstring-to-quadriceps ratio was 4% greater in ACL deficient than in uninjured limbs (95% CI: 1.7% to 6.3%; P<0.001). Conclusively, Decreases were observed in both the quadriceps and hamstring muscles of patients with ACL tear, with the decrease in quadriceps strength being 3-fold greater. These uneven reductions slightly increase the hamstring-to-quadriceps ratio in ACL deficient knees.

Influence of Anterior Cruciate Ligament Tear on Thigh Muscle Strength and Hamstring-to-Quadriceps Ratio: A Meta-Analysis

PubMed Central

Ahn, Sung-Eun; Park, Min-Ji; Lee, Dae-Hee

2016-01-01

Theoretical compensation after anterior cruciate ligament (ACL) tear could cause quadriceps weakness and hamstring activation, preventing anterior tibial subluxation and affecting the expected hamstring-to-quadriceps ratio. Although quadriceps weakness often occurs after ACL tears, it remains unclear whether hamstring strength and hamstring-to-quadriceps ratio increase in ACL deficient knees. This meta-analysis compared the isokinetic muscle strength of quadriceps and hamstring muscles, and the hamstring-to-quadriceps ratio, of the injured and injured limbs of patients with ACL tears. This meta-analysis included all studies comparing isokinetic thigh muscle strengths and hamstring-to-quadriceps ratio in the injured and uninjured legs of patients with ACL tear, without or before surgery. Thirteen studies were included in the meta-analysis. Quadriceps and hamstring strengths were 22.3 N∙m (95% CI: 15.2 to 29.3 N∙m; P<0.001) and 7.4 N∙m (95% CI: 4.3 to 10.5 N∙m; P<0.001) lower, respectively, on the injured than on the uninjured side. The mean hamstring-to-quadriceps ratio was 4% greater in ACL deficient than in uninjured limbs (95% CI: 1.7% to 6.3%; P<0.001). Conclusively, Decreases were observed in both the quadriceps and hamstring muscles of patients with ACL tear, with the decrease in quadriceps strength being 3-fold greater. These uneven reductions slightly increase the hamstring-to-quadriceps ratio in ACL deficient knees. PMID:26745808

Multiple arthroscopic debridement and graft retention in septic knee arthritis after ACL reconstruction: a prospective case-control study.

PubMed

Abdel-Aziz, Ahmed; Radwan, Yasser A; Rizk, Ahmed

2014-01-01

This study was undertaken to prospectively analyse, at a mean five-year follow-up, the clinical, functional, and radiographic outcomes in patients who developed postoperative acute septic knee arthritis following anterior cruciate ligament (ACL) reconstruction using hamstring autograft. We also assessed the effect of multiple arthroscopic debridement and graft retention on the functional outcomes in comparison with the matched control group. From a consecutive case series of 2,560 ACL-injured patients who were treated with arthroscopic ACL reconstruction, we report on 24 cases with postoperative septic knee arthritis. These patients were individually matched for age, sex, comorbidity, body mass index (BMI) and preinjury Tegner activity scale in a ratio of 1/1. Clinical, laboratory, synovial fluid analysis and culture were performed. Arthroscopic debridement and graft retention was done for all cases, in addition to antibiotic therapy i.v.. A detailed physical examination, KT1000 laxity testing, Lysholm knee score, Tegner activity level scale, International Knee Documentation Committee (IKDC), and Knee Injury and Osteoarthritis Outcome Score (KOOS) were completed. In all cases, treatment of infection was successful after a median of three (range one to six) repeated arthroscopic graft debridement and retention, in addition to antibiotic therapy i.v.. At an average of five years follow-up, two patients had over five millimetres manual maximum side-to-side difference in laxity. There were no significant differences between groups regarding Lysholm score, IKDC and KOOS. Median final Tegner activity score was 5.5 versus 7 in the control group (p = 0.004). Complications included graft rupture in three patients, loss of range of motion in five, Sudeck's atrophy in one and moderate joint narrowing in two. There were no recurrences of septic arthritis or bone infection. Graft retention seems not only possible but appropriate in view of the experience presented in this

Return to Play After Hamstring Injuries: A Qualitative Systematic Review of Definitions and Criteria.

PubMed

van der Horst, Nick; van de Hoef, Sander; Reurink, Gustaaf; Huisstede, Bionka; Backx, Frank

2016-06-01

More than half of the recurrent hamstring injuries occur within the first month after return-to-play (RTP). Although there are numerous studies on RTP, comparisons are hampered by the numerous definitions of RTP used. Moreover, there is no consensus on the criteria used to determine when a person can start playing again. These criteria need to be critically evaluated, in an attempt to reduce recurrence rates and optimize RTP. To carry out a systematic review of the literature on (1) definitions of RTP used in hamstring research and (2) criteria for RTP after hamstring injuries. Systematic review. Seven databases (PubMed, EMBASE/MEDLINE, CINAHL, PEDro, Cochrane, SPORTDiscus, Scopus) were searched for articles that provided a definition of, or criteria for, RTP after hamstring injury. There were no limitations on the methodological design or quality of articles. Content analysis was used to record and analyze definitions and criteria for RTP after hamstring injury. Twenty-five papers fulfilled inclusion criteria, of which 13 provided a definition of RTP and 23 described criteria to support the RTP decision. "Reaching the athlete's pre-injury level" and "being able to perform full sport activities" were the primary content categories used to define RTP. "Absence of pain", "similar strength", "similar flexibility", "medical staff clearance", and "functional performance" were core themes to describe criteria to support the RTP decision after hamstring injury. Only half of the included studies provided some definition of RTP after hamstring injury, of which reaching the athlete's pre-injury level and being able to perform full sport activities were the most important. A wide variety of criteria are used to support the RTP decision, none of which have been validated. More research is needed to reach a consensus on the definition of RTP and to provide validated RTP criteria to facilitate hamstring injury management and reduce hamstring injury recurrence. PROSPERO

The relationship between hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction

PubMed Central

Massoud Arab, Amir; Reza Nourbakhsh, Mohammad; Mohammadifar, Ali

2011-01-01

It has been suggested that tight hamstring muscle, due to its anatomical connections, could be a compensatory mechanism for providing sacroiliac (SI) joint stability in patients with gluteal muscle weakness and SIJ dysfunction. The purpose of this study was to determine the relationship between hamstring muscle length and gluteal muscle strength in subjects with sacroiliac joint dysfunction. A total of 159 subjects with and without low back pain (LBP) between the ages of 20 and 65 years participate in the study. Subjects were categorized into three groups: LBP without SIJ involvement (n = 53); back pain with SIJ dysfunction (n = 53); and no low back pain (n = 53). Hamstring muscle length and gluteal muscle strength were measured in all subjects. The number of individuals with gluteal weakness was significantly (P = 0.02) higher in subjects with SI joint dysfunction (66%) compared to those with LBP without SI joint dysfunctions (34%). In pooled data, there was no significant difference (P = 0.31) in hamstring muscle length between subjects with SI joint dysfunction and those with back pain without SI involvement. In subjects with SI joint dysfunction, however, those with gluteal muscle weakness had significantly (P = 0.02) shorter hamstring muscle length (mean = 158±11°) compared to individuals without gluteal weakness (mean = 165±10°). There was no statistically significant difference (P>0.05) in hamstring muscle length between individuals with and without gluteal muscle weakness in other groups. In conclusion, hamstring tightness in subjects with SI joint dysfunction could be related to gluteal muscle weakness. The slight difference in hamstring muscle length found in this study, although statistically significant, was not sufficient for making any definite conclusions. Further studies are needed to establish the role of hamstring muscle in SI joint stability. PMID:22294848

The relationship between hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction.

PubMed

Massoud Arab, Amir; Reza Nourbakhsh, Mohammad; Mohammadifar, Ali

2011-02-01

It has been suggested that tight hamstring muscle, due to its anatomical connections, could be a compensatory mechanism for providing sacroiliac (SI) joint stability in patients with gluteal muscle weakness and SIJ dysfunction. The purpose of this study was to determine the relationship between hamstring muscle length and gluteal muscle strength in subjects with sacroiliac joint dysfunction. A total of 159 subjects with and without low back pain (LBP) between the ages of 20 and 65 years participate in the study. Subjects were categorized into three groups: LBP without SIJ involvement (n = 53); back pain with SIJ dysfunction (n = 53); and no low back pain (n = 53). Hamstring muscle length and gluteal muscle strength were measured in all subjects. The number of individuals with gluteal weakness was significantly (P = 0.02) higher in subjects with SI joint dysfunction (66%) compared to those with LBP without SI joint dysfunctions (34%). In pooled data, there was no significant difference (P = 0.31) in hamstring muscle length between subjects with SI joint dysfunction and those with back pain without SI involvement. In subjects with SI joint dysfunction, however, those with gluteal muscle weakness had significantly (P = 0.02) shorter hamstring muscle length (mean = 158±11°) compared to individuals without gluteal weakness (mean = 165±10°). There was no statistically significant difference (P>0.05) in hamstring muscle length between individuals with and without gluteal muscle weakness in other groups. In conclusion, hamstring tightness in subjects with SI joint dysfunction could be related to gluteal muscle weakness. The slight difference in hamstring muscle length found in this study, although statistically significant, was not sufficient for making any definite conclusions. Further studies are needed to establish the role of hamstring muscle in SI joint stability.

The functional significance of hamstrings composition: is it really a "fast" muscle group?

PubMed

Evangelidis, Pavlos E; Massey, Garry J; Ferguson, Richard A; Wheeler, Patrick C; Pain, Matthew T G; Folland, Jonathan P

2017-11-01

Hamstrings muscle fiber composition may be predominantly fast-twitch and could explain the high incidence of hamstrings strain injuries. However, hamstrings muscle composition in vivo, and its influence on knee flexor muscle function, remains unknown. We investigated biceps femoris long head (BFlh) myosin heavy chain (MHC) composition from biopsy samples, and the association of hamstrings composition and hamstrings muscle volume (using MRI) with knee flexor maximal and explosive strength. Thirty-one young men performed maximal (concentric, eccentric, isometric) and explosive (isometric) contractions. BFlh exhibited a balanced MHC distribution [mean ± SD (min-max); 47.1 ± 9.1% (32.6-71.0%) MHC-I, 35.5 ± 8.5% (21.5-60.0%) MHC-IIA, 17.4 ± 9.1% (0.0-30.9%) MHC-IIX]. Muscle volume was correlated with knee flexor maximal strength at all velocities and contraction modes (r = 0.62-0.76, P < 0.01), but only associated with late phase explosive strength (time to 90 Nm; r = -0.53, P < 0.05). In contrast, BFlh muscle composition was not related to any maximal or explosive strength measure. BFlh MHC composition was not found to be "fast", and therefore composition does not appear to explain the high incidence of hamstrings strain injury. Hamstrings muscle volume explained 38-58% of the inter-individual differences in knee flexor maximum strength at a range of velocities and contraction modes, while BFlh muscle composition was not associated with maximal or explosive strength. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Acute Effects of Hamstring Stretching on Sagittal Spinal Curvatures and Pelvic Tilt

PubMed Central

López-Miñarro, Pedro A.; Muyor, José M.; Belmonte, Felipe; Alacid, Fernando

2012-01-01

The aim of this study was to determine acute effects of hamstring stretching in thoracic and lumbar spinal curvatures and pelvic tilt. Fifty-five adults (29.24 ± 7.41 years) were recruited for this study. Subjects performed a hamstring stretching protocol consisting of four exercises. The session consisted of 3 sets of each exercise and subjects held the position for 20 seconds with a 30-second rest period between sets and exercises. Thoracic and lumbar spinal angles and pelvic tilt were measured with a SpinalMouse in relaxed standing, sit-and-reach test and Macrae & Wright position. Hamstring extensibility was determined by active straight leg raise test and sit-and-reach score. All measures were performed before and immediately after the hamstring stretching protocol. Active straight leg raise angle and sitand-reach score significantly improved immediately after the stretching protocol (p<0.001). Greater anterior pelvic tilt (p<0.001) and lumbar flexion (p<0.05) and a smaller thoracic kyphosis in the sit-and-reach (p<0.001) were found after the stretching protocol. However, stretching produced no significant change on spinal curvatures or pelvic tilt in standing and maximal trunk flexion with knees flexed. In conclusion, static stretching of the hamstring is associated to an immediate change in the sagittal spinal curvatures and pelvic position when performing trunk flexion with knees extended, so that allowing for greater lumbar flexion and anterior pelvic tilt and lower thoracic kyphosis. Hamstring stretching is recommended prior to sport activities involving trunk flexion with the knees straight. PMID:23486214

How joint torques affect hamstring injury risk in sprinting swing-stance transition.

PubMed

Sun, Yuliang; Wei, Shutao; Zhong, Yunjian; Fu, Weijie; Li, Li; Liu, Yu

2015-02-01

The potential mechanisms of hamstring strain injuries in athletes are not well understood. The study, therefore, was aimed at understanding hamstring mechanics by studying loading conditions during maximum-effort overground sprinting. Three-dimensional kinematics and ground reaction force data were collected from eight elite male sprinters sprinting at their maximum effort. Maximal isometric torques of the hip and knee were also collected. Data from the sprinting gait cycle were analyzed via an intersegmental dynamics approach, and the different joint torque components were calculated. During the initial stance phase, the ground reaction force passed anteriorly to the knee and hip, producing an extension torque at the knee and a flexion torque at the hip joint. Thus, the active muscle torque functioned to produce flexion torque at the knee and extension torque at the hip. The maximal muscle torque at the knee joint was 1.4 times the maximal isometric knee flexion torque. During the late swing phase, the muscle torque counterbalanced the motion-dependent torque and acted to flex the knee joint and extend the hip joint. The loading conditions on the hamstring muscles were similar to those of the initial stance phase. During both the initial stance and late swing phases, the large passive torques at both the knee and hip joints acted to lengthen the hamstring muscles. The active muscle torques generated mainly by the hamstrings functioned to counteract those passive effects. As a result, during sprinting or high-speed locomotion, the hamstring muscles may be more susceptible to high risk of strain injury during these two phases.

Secure fixation of femoral bone plug with a suspensory button in anatomical anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft

PubMed Central

TAKETOMI, SHUJI; INUI, HIROSHI; NAKAMURA, KENSUKE; YAMAGAMI, RYOTA; TAHARA, KEITARO; SANADA, TAKAKI; MASUDA, HIRONARI; TANAKA, SAKAE; NAKAGAWA, TAKUMI

2015-01-01

Purpose the efficacy and safety of using a suspensory button for femoral fixation in anatomical anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) graft have not been established. The purpose of the current study was to evaluate bone plug integration onto the femoral socket and migration of the bone plug and the EndoButton (EB) (Smith & Nephew, Andover, MA, USA) after rectangular tunnel ACL reconstruction with BPTB autograft. Methods thirty-four patients who underwent anatomical rectangular ACL reconstruction with BPTB graft using EB for femoral fixation and in whom three-dimensional (3D) computed tomography (CT) was performed one week and one year after surgery were included in this study. Bone plug integration onto the femoral socket, bone plug migration, soft tissue interposition, EB migration and EB rotation were evaluated on 3D CT. The clinical outcome was also assessed and correlated with the imaging outcomes. Results the bone plug was integrated onto the femoral socket in all cases. The incidence of bone plug migration, soft tissue interposition, EB migration and EB rotation was 15, 15, 9 and 56%, respectively. No significant association was observed between the imaging outcomes. The postoperative mean Lysholm score was 97.1 ± 5.0 points. The postoperative side-to-side difference, evaluated using a KT-2000 arthrometer, averaged 0.5 ± 1.3 mm. There were no complications associated with EB use. Imaging outcomes did not affect the postoperative KT side-to-side difference. Conclusions the EB is considered a reliable device for femoral fixation in anatomical rectangular tunnel ACL reconstruction with BPTB autograft. Level of evidence Level IV, therapeutic case series. PMID:26889465

Sciatic Nerve Conductivity is Impaired by Hamstring Strain Injuries.

PubMed

Kouzaki, Karina; Nakazato, Koichi; Mizuno, Masuhiko; Yonechi, Tooru; Higo, Yusuke; Kubo, Yoshiaki; Kono, Tokuyoshi; Hiranuma, Kenji

2017-10-01

The aim of this study was to assess sciatic nerve conductivity in athletes with a history of hamstring strain injuries. Twenty-seven athletes with a history of hamstring strain injuries were included in the injured group. The control group consisted of 16 uninjured participants. We measured the proximal and distal latencies and calculated the sciatic nerve conduction velocity to evaluate neuronal conductivity. The results were expressed as median values and interquartile ranges. Both proximal latency and distal latency of the injured limb in the injured group were significantly longer than those of the uninjured limb (p<0.05). The nerve conduction velocity of the injured limb in the injured group was significantly lower than that of the uninjured limb (p<0.05). There were no significant side-to-side differences in the control group. Sciatic nerve conductivity impairments may exist in athletes with a history of hamstring strain injuries. © Georg Thieme Verlag KG Stuttgart · New York.

Proximal hamstring reconstruction using semitendinosus and gracilis autograft: a novel technique.

PubMed

Muellner, Thomas; Kumar, Sandeep; Singla, Amit

2017-01-01

The complete proximal hamstring avulsion is relatively uncommon injury and predominantly occurs in young athletes but causes significant functional impairment. In chronic cases, the muscle mass is so much retracted that primary repair is not possible. A surgical technique for reconstruction of chronic proximal hamstring avulsion using contralateral semitendinosus and gracilis autograft is described in this case report. V.

Contractile function and motor unit firing rates of the human hamstrings

PubMed Central

Kirk, Eric A.

2016-01-01

Neuromuscular properties of the lower limb in health, aging, and disease are well described for major lower limb muscles comprising the quadriceps, triceps surae, and dorsiflexors, with the notable exception of the posterior thigh (hamstrings). The purpose of this study was to further characterize major muscles of the lower limb by comprehensively exploring contractile properties in relation to spinal motor neuron output expressed as motor unit firing rates (MUFRs) in the hamstrings of 11 (26.5 ± 3.8) young men. Maximal isometric voluntary contraction (MVC), voluntary activation, stimulated contractile properties including a force-frequency relationship, and MUFRs from submaximal to maximal voluntary contractile intensities were assessed in the hamstrings. Strength and MUFRs were assessed at two presumably different muscle lengths by varying the knee joint angles (90° and 160°). Knee flexion MVCs were 60–70% greater in the extended position (160°). The frequency required to elicit 50% of maximum tetanic torque was 16–17 Hz. Mean MUFRs at 25–50% MVC were 9–31% less in the biceps femoris compared with the semimembranosus-semitendinosus group. Knee joint angle (muscle length) influenced MUFRs such that mean MUFRs were greater in the shortened (90°) position at 50% and 100% MVC. Compared with previous reports, mean maximal MUFRs in the hamstrings are greater than those in the quadriceps and triceps surae and somewhat less than those in the tibialis anterior. Mean maximal MUFRs in the hamstrings are influenced by changes in knee joint angle, with lower firing rates in the biceps femoris compared with the semimembranosus-semitendinosus muscle group. NEW & NOTEWORTHY We studied motor unit firing rates (MUFRs) at various voluntary contraction intensities in the hamstrings, one of the only major lower limb muscles to have MUFRs affected by muscle length changes. Within the hamstrings muscle-specific differences have greater impact on MUFRs than length changes

[The application of delayed skin grafting combined traction in severe joint cicatricial contracture].

PubMed

Xu, Zihan; Zhang, Zhenxin; Wang, Benfeng; Sun, Yaowen; Guo, Yadong; Gao, Wenjie; Qin, Gaoping

2014-11-01

To investigate the effect of delayed skin grafting combined traction in severe joint cicatricial contracture. At the first stage, the joint cicatricial contracture was released completely with protection of vessels, nerves and tendons. The wound was covered with allogenetic skin or biomaterials. After skin traction for 7-14 days, the joint could reach the extension position. Then the skin graft was performed on the wound. 25 cases were treated from Mar. 2000 to May. 2013. Primary healing was achieved at the second stage in all the cases. The skin graft had a satisfactory color and elasticity. Joint function was normal. All the patients were followed up for 3 months to 11 years with no hypertrophic scar and contraction relapse, except for one case who didn' t have enough active exercise on shoulder joint. Delayed skin grafting combined traction can effectively increase the skin graft survival rate and improve the joint function recovery.